Recent advances in pharmacologic neuroprotection.
Although there is a continual improvement in the understanding of the pathophysiology of brain ischaemia and reperfusion, the pharmacological approach of treating or preventing brain ischaemic injury has had limited clinical impact so far. The great majority of clinical trials testing neuroprotectants for the treatment of acute ischaemic stroke have failed to demonstrate any benefit on any major outcome endpoint. Several strategies combining physiologic (oxygen, hypothermia), pharmacologic (erythopoietin derivatives) and thrombolytic therapies may, however, be promising in future, provided a more rigorous design of the clinical trials is achieved. The place of anaesthetics as clinical effective neuroprotectants in the perioperative period remains to be established.
Mantz
Jean
J
Department of Anesthesia, Beuajon University Hospital, Clichy, France. jean.mantz@bj.aphp.fr
Degos
Vincent
V
Laigle
Christophe
C
D000758:Anesthesia / Q000379:methods / Q000639:trends*; D000818:Animals; D017209:Apoptosis; D002545:Brain Ischemia / Q000188:drug therapy; D002986:Clinical Trials as Topic; D006801:Humans; D007035:Hypothermia / Q000473:pathology; D009474:Neurons / Q000187:drug effects*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D018384:Oxidative Stress; D015427:Reperfusion Injury; D012107:Research Design; D020521:Stroke / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
D018696:Neuroprotective Agents