Brain Protection In Cardiac Surgery

Part of the Monographs in Cardiac Surgery Series – Introducing ‘basic science into the cardiac operating room’. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery ‘tomes’. This entry into the series will provide readers with a complete review of the current understanding in brain injury and the methods used to avoid or limit its effects on patient morbidity and mortality.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr.

This book is a knowledge-based text that covers the anatomy, neurophysiology, and neuropharmacology needed to carry out the necessary management and cerebrospinal protection during neuroanesthesia. Especially to make the subject of neuroanesthesia more approachable, we introduce surgical measures utilized in neurosurgery, cardiovascular surgery, neuromodulation, and related procedures. The main purpose of neuroanesthesia/neurocritical care is to deliver cerebrospinal protection in neurosurgical and cardiovascular surgeries. How should we select the best anesthetic management to prevent neurological complications for patients who, for instance, undergo different types of surgery for subarachnoid hemorrhage, stroke, head trauma, carotid endarterectomy, or cardiovascular surgery under cardiopulmonary bypass? These pathological conditions include the risk of transient cerebrospinal ischemia, and if our management is not precise, it may induce serious neurological sequelae. Although there is an urgent need to establish the treatment and elucidate the molecular mechanisms of cerebrospinal injury, many components are intertwined, making this a challenge we have not completely solved yet. This volume makes the management of neuroanesthesia more accessible not only for primary residents but also for specialists, providing a valuable resource on the current perspectives of neuroanesthesia.

Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.

Among the greatest challenges in cardiovascular surgery today remain operations on aortic arch pathology, supraaortic vessels, and the protection of the brain from hypoxic or ischemic injury during these delicate operations. Since DeBakey's first successful repair of an aortic arch aneurysm in 1957, understanding of the aortic arch pathology, neuroprotective strategies, neuromonitoring and surgical technique have markedly improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have contributed to ongoing controversy. Cerebral Protection in Cerebrovascular and Aortic Surgery presents the current knowledge of understanding causes and pathogenesis of cerebral damage during surgery on the aortic arch and supraaortic vessels and prevention of brain damage by specific surgical therapy.

Georg Rodewald University of Hamburg Hamburg, Federal Republic of Germany Allen E. Willner Hillside Hospital Glen Oaks, NY In contrast to the initial years of cardiac surgery (37 years ago), there is now increasing interest in cerebral protection. Rodewald [1] in 1978 was among the first to point out the surgeon's concern with "psychopathological problems" and Taylor [2] in 1989 stressed that" ••• the awareness of the cerebral consequences of open heart surgery has risen considerably in recent years • • • " This book reviews the evidence for neurological, psychological, and neuropsycho logical reactions to cardiac surgery. In previous studies one problem is that small samples of patients were studied with different measuring instruments so that it was difficult to ma~e sense of inconsistent findings. Considerable controversy resulted with little ability to sort out discrepant findings. It appeared that a large multi center study using uniform measures might help clarify the picture.

Since the publication of the first edition of Core Topics in Cardiac Anaesthesia, the clinical landscape has undergone significant change. Recent developments include the increased use of electrophysiology, the resurgence of primary percutaneous intervention in acute coronary syndromes, the use of percutaneous devices in patients previously considered inoperable, and the withdrawal of aprotinin. Against this landscape, this invaluable resource has been fully updated. New chapters are dedicated to right heart valves, pulmonary vascular disease, cardiac tumours and cardiac trauma. All other chapters have been updated according to the latest international guidelines. Written and edited by an international author team with a wealth of expertise in all aspects of the perioperative care of cardiac patients, topics are presented in an easy to digest and a readily accessible manner. Core Topics in Cardiac Anaesthesia, Second Edition is essential reading for residents and fellows in anaesthesia and cardiac surgery and clinical perfusionists.

This book provides a comprehensive overview of the multitude of different forms of thermotherapy in connection with aspects of thermal physiology and cell biology. The aim is to elucidate the scientific background of therapeutic actions and to promote effective new applications at the beginning of the 21st century. Significant to these purposes is cooperation between experts in the fields of thermal biology, hyper thermic oncology, rheumatology, and balneology, as represented by the editors. Emphasis has been placed on a balanced choice of contributions, in the hope that this will enable the reader to draw helpful connections between the principles and prac tice of thermotherapy. It is apparent that a wealth of published data exists concerning thermotherapy on the one hand and thermal physiology on the other. However, in the former field empirical aspects of therapeutic usefulness prevail, while in the latter, aspects of basic science are in the foreground. Accordingly, the sources where published data may be found are quite different and as a consequence many findings of potential mutual interest published in medical journals have gone unnoticed by readers of physio logical journals, and vice versa. It is hoped that this book will bridge the gap and encourage researchers' efforts to integrate the available knowledge to attain optimal coordination of clinical and theoretical aspects.