Pharmacological neuroprotection during cardiac surgery.
Despite more than 30 years of aggressive neuroprotective research by many investigators, neuropsychological deficit after cardiac surgery remains an important cause of postoperative morbidity. Although the neurological outcome is a result of a multifactorial etiology, many physicians world-wide have recognized the importance of this problem, and extensive efforts have been made in attempting to minimize the incidence of neurological and neurocognitive dysfunction. Pharmacological intervention is one of the important potential methods of neuroprotection during cardiac surgery. In vitro studies have identified drugs that are effective protectants against focal cerebral ischemia, hemorrhage, and global ischemia. However, at present there is no solid agreement on the need for prophylactic neuroprotectants in cardiac surgery. Researchers and clinicians must become more cognizant of the pitfalls and paradoxes that have arisen in attempting to translate the results of animal studies into clinical trial, with regard to neuroprotective therapy during cardiac surgery. There is an extensive need for new pharmacological approaches directed at reducing neurologic and neurocognitive injury during cardiac surgery. This article reviews past and present neuroprotective efforts and interventions during cardiac surgery.
Kadoi
Yuji
Y
Department of Anesthesiology, Gunma University, Graduate School of Medicine, Gunma, Japan. kadoi@med.gunma-u.ac.jp
D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016166:Free Radical Scavengers / Q000627:therapeutic use; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D019194:Ischemic Preconditioning; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control*; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors
D002121:Calcium Channel Blockers; D016166:Free Radical Scavengers; D018757:GABA Modulators; D018696:Neuroprotective Agents; D016194:Receptors, N-Methyl-D-Aspartate