Pathophysiological basis of CNS injury in cardiac surgical patients: detection and prevention.
The current understanding of adverse central nervous system (CNS) events following cardiac surgery involves several identifiable, evidence-based mechanisms: atherosclerotic emboli, microgaseous and microparticulate emboli, and hypoperfusion. Secondary factors, including patient co-morbidities and inherent genetic susceptibilities, as well as systemic inflammatory processes and a suboptimal metabolic milieu may interact to potentiate the extent of injury. In this review a number of these factors and their potential interactions will be explored with a view towards developing a comprehensive management strategy to minimize CNS injury.
Murkin
John M
JM
University of Western Ontario, London, Ont, Canada. jmurkin@uwo.ca
D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006331:Heart Diseases / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control