Cerebral injury during paediatric heart surgery: perfusion issues.
Suboptimal neurodevelopmental outcome is common in children who have congenital heart disease. Its aetiology is often multifactorial. This review focuses on the role of cardiopulmonary bypass. Hypothermia is the mainstay of cerebral protection. Low flow and regional low flow are preferred to deep hypothermic circulatory arrest in many situations. Cooling and rewarming, aortopulmonary collaterals, pH, air emboli, the systemic inflammatory response, haematocrit, oxygenation, glucose and ultrafiltration can influence neurodevelopmental outcome. Although no pharmacological agents have been shown to have a beneficial effect on neurodevelopmental outcome in clinical practice in children, animal work on the use of steroids several hours before surgery is encouraging.
Scallan
Michael J H
MJ
Department of Anaesthesia, Royal Brompton Hospital, London, UK. M.Scallan@rbh.nthames.nhs.uk
D000818:Animals; D001831:Body Temperature; D001930:Brain Injuries / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D002648:Child; D003080:Cold Temperature; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D010101:Oxygen Consumption; D015424:Reperfusion / Q000009:adverse effects; D015427:Reperfusion Injury / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use
D013256:Steroids