Seminars in Cardiothoracic and Vascular Anesthesia

 

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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 4, No. 2, 53-64 (2000)
DOI: 10.1053/vc.2000.6499

Strategies to Protect the Brain During Cardiac Surgery

Mark F. Newman

Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, NC

Timothy O. Stanley

Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, NC

Hilary P. Grocott

Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, NC

Despite significant advances in cardiopulmonary by pass (CPB) technology, surgical techniques, and anes thetic management, central nervous system (CNS) com plications remain a common and costly problem after CPB. Stroke is often considered a rare and unprevent able complication of cardiac surgery. Recent studies have shown that through the use of echocardiography and historical risk stratification strategies, we can de fine which patients are at substantially greater risk for CNS injury. Through enhanced understanding of the etiology of stroke and perioperative factors, which are associated with potential for neuroprotection or injury extension, there now exists a greater potential than ever to substantially reduce neurological injury associ ated with cardiac surgery. Strategies and theories of stratifying patients at risk and secondarily reducing that risk are described, as well as consideration for early postoperative assessment to allow treatment when events occur.


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