ECENT UPDATES IN BRAIN PROTECTION DURING CARDIAC SURGERY

Abstract

SUMMARY I n patients undergoing cardiac surgery, multiple complications related to CNS can occur during this critical operation such as stroke, encephalopathy, POD(post-operative-delirium), behavioural changes, seizures and other several complications due to several etiologies such as emboli, temperature, inflammatory response, non-pulsatile flow and brain edema. Central nervous system related complication during cardiac surgery can be classified into: focal, multifocal and global. Multiple risk factors are known and have the upper hand in increasing the risk of occurring of complication related to CNS as age, gender, history of diabetes mellitus, history of cerebrovascular diseases, genetic predisposition, temperature, hematocrit value and time consumed in cardiopulmonary bypass. Multiple approaches are necessary to optimize brain protection and minimize the risk of complications and neurologic injury. The main components of brain protective strategies are reducing cerebral emboli using off-pump, improving cerebral oxygen balance by keeping meanarterial blood pressure between 80 mmHg and 90 mmHg, red cell transfusion, temperature management, neuromonitoring using NIRS(near-infrared spectroscopy, protecting ischemic penumbera, the maintenance of arterial carbon dioxide tension between 35-38 mmHg and finally blood glucose control. Other important components for brain protection against ischemic cerebral injury have been used during cardiac surgery as barbiturates, calcium channel blockers, antioxidants, propofol, magnesium, ketamine, erythropoietin and other agents. So Brain protective strategies can be classified into 2 categories: pharmacological and non-pharmacological. The implementation of these approach, combined with ongoing improvements in surgical techniques, has led to dramatically improved patient outcomes; the risks of stoke and early death after cardiac surgery have both been reduced.