Anesthesia and brain protection in reconstructive surgery of brachiocephalic arteries

Application of a shunt is not the principal factor preventing brain blood flow disorders in reconstructive surgery on the carotid arteries in conditions of general anesthesia with anesthetics of an antihypoxic action, reducing oxygen consumption by the brain, combined with adequate compensation of the circulating blood volume, moderate hemodilution, elevation of the systemic arterial pressure and heparin. The authors claim that even in patients with bilateral stenosis of the carotid arteries or with occlusion of one of these arteries surgery may be carried out without shunts or craniocerebral hypothermia. Still, they do not deny a bypass application, particularly by the surgeons who always use it, or in cases with a drastic inhibition of the brain electrical activity, evidenced by EEG, which they consider a sufficiently reliable indicator of the brain blood flow adequacy.