Anesthetic Protection in Brain Ischemia

This review will be confined to the use of anesthetics for protection of the brain during surgery in which either the disease of the patients or the surgery itself places the patient at risk of cerebral ischemia. This could include patients with intracranial pathology or cerebrovascular disease undergoing any surgical procedure, and any patient undergoing cardiovascular or neurosurgery especially if there may be temporary occlusion of a major cerebral artery. Intraoperative cerebral ischemia may be focal ischemia due to the temporary clamping of a major cerebral vessel, to emboli produced by blood clot, air, or particulate matter, or to focal cerebral edema secondary to surgery trauma. Intraoperative cerebral ischemia may also be global but incomplete as that which may occur during hemorrhagic or cardiogenic shock, but also could be the result of such low flow states as induced (deliberate) hypotension or during cardiopulmonary bypass (Table 1).