Brain Protection In Cardiac Surgery

Part of the Monographs in Cardiac Surgery Series – Introducing ‘basic science into the cardiac operating room’. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery ‘tomes’. This entry into the series will provide readers with a complete review of the current understanding in brain injury and the methods used to avoid or limit its effects on patient morbidity and mortality.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr.

Among the greatest challenges in cardiovascular surgery today remain operations on aortic arch pathology, supraaortic vessels, and the protection of the brain from hypoxic or ischemic injury during these delicate operations. Since DeBakey's first successful repair of an aortic arch aneurysm in 1957, understanding of the aortic arch pathology, neuroprotective strategies, neuromonitoring and surgical technique have markedly improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have contributed to ongoing controversy. Cerebral Protection in Cerebrovascular and Aortic Surgery presents the current knowledge of understanding causes and pathogenesis of cerebral damage during surgery on the aortic arch and supraaortic vessels and prevention of brain damage by specific surgical therapy.

Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book, with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have preoperative cerebral impairment, not suprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how imaging techniques (CT scan, MRI, regional cerebral blood flow imaging), and functional assessment techniques. (PET scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).

This book is a knowledge-based text that covers the anatomy, neurophysiology, and neuropharmacology needed to carry out the necessary management and cerebrospinal protection during neuroanesthesia. Especially to make the subject of neuroanesthesia more approachable, we introduce surgical measures utilized in neurosurgery, cardiovascular surgery, neuromodulation, and related procedures. The main purpose of neuroanesthesia/neurocritical care is to deliver cerebrospinal protection in neurosurgical and cardiovascular surgeries. How should we select the best anesthetic management to prevent neurological complications for patients who, for instance, undergo different types of surgery for subarachnoid hemorrhage, stroke, head trauma, carotid endarterectomy, or cardiovascular surgery under cardiopulmonary bypass? These pathological conditions include the risk of transient cerebrospinal ischemia, and if our management is not precise, it may induce serious neurological sequelae. Although there is an urgent need to establish the treatment and elucidate the molecular mechanisms of cerebrospinal injury, many components are intertwined, making this a challenge we have not completely solved yet. This volume makes the management of neuroanesthesia more accessible not only for primary residents but also for specialists, providing a valuable resource on the current perspectives of neuroanesthesia.

Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.

An estimated 30,000 children are born in the USA with congenital heart disease each year, two thirds of which will require corrective surgery. Medical advances have formed a trend of operating on newborns rather than waiting until the child is older. Ten years ago, the mortality for these operationswas 60% to 70%. That percentage has dropped to 2%. This specialized book explores the basic mechanisms of neurologic injury associated with congenital heart surgery while covering the emerging technologies for assessment of neurologic integrity and injury. The text also highlights the current and future techniques for reducing and preventing these injuries, and reviews the pertinent medicolegal issues.