title: Cerebral protection during neurosurgery and stroke.
abstract: OBJECTIVE
  This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain surgery and in patients with acute stroke.
  
  
  RESULTS
  With varying degrees of success, numerous pharmacological and nonpharmacological therapies have been employed to provide neuroprotection for patients during the perioperative period and after acute ischemic stroke (IAS). Recent studies have failed to demonstrate neuroprotective effects of intraoperative remifentanil or propofol use, although hypertonic saline may provide better brain relaxation than mannitol during elective intracranial surgery for tumor. Magnesium sulfate offers no improvement in neurological outcome at 90 days after stroke. Medical management alone may be superior to medical management with interventional therapy for the prevention of death or stroke in unruptured arteriovenous malformations. In patients with IAS with a proximal vessel occlusion, small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment resulted in improved functional outcomes and reduced mortality. For endovascular clot evacuation after IAS, conscious sedation may be safer than general anaesthesia.
  
  
  CONCLUSIONS
  Recent evidence provides insufficient evidence of neuroprotective strategies to guide clinical management, and more randomized clinical trials are needed to optimize patient care.
authors: aDepartment of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari Valencia, University of Valencia, Valencia, Spain. bDepartment of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut USA cDepartment of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy.
authors: Rafael
authors: R
authors: Badenes
authors: Shaun E
authors: SE
authors: Gruenbaum
authors: Federico
authors: F
authors: Bilotta
mesh_terms: D002545:Brain Ischemia; D006801:Humans; D000066829:Neuroprotection; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D020521:Stroke / Q000628:therapy*