J Anesth Perioper Med. 2017;4(1):1-6. https://doi.org/10.24015/ebcmed.japm.2017.0004

Pharmacological Cerebral Protection in Cardiac Surgery: An Update

Henry Liu1, Rayhan Tariq1, Geoffrey Liu1, and Ling Yu2

From 1Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA; 2Department of Anesthesiology, Hubei Women & Children's Hospital, Wuhan, China.

*Contributed equally to this work.

Correspondence to Dr. Henry Liu at henryliupa@gmail.com.

EBCMED ID: ebcmed.japm.2017.0004 DOI: 10.24015/ebcmed.japm.2017.0004


Aim of review
Postoperative cognitive dysfunction (POCD) remains a major issue in cardiovascular surgery, although advances have been made in anesthesia, surgery and neuroprotective measures. Pharmacological prevention and management of POCD has achieved some progress over the last one to two decades, yet no consensus or guideline being established.

The following key words in PubMed were searched: cerebral protection, brain protection, cardiac surgery, and postoperative cognitive decline, etc. Recent articles and literatures were searched and reviewed on the risk factors for POCD and the cerebral protective effects of pharmacological agents, in order to make a comprehensive review and offer an update.

Recent findings
Risk factors for POCD reported in literatures include older age, male gender, cardiopulmonary bypass (CPB) use, cerebral embolization, pre-existing cognitive disturbance and genetic predisposition. The pharmacological agents with potential neuroprotective effects include volatile anesthetics, intravenous anesthetic agents, steroids, N-methyl-D-aspartate (NMDA) antagonists, nitric oxide carriers and some traditional Chinese herbal medicine such as gastrodin. Cerebral protection in current practice is achieved by a combination of different strategies including surgical (cerebral perfusion during CPB, aortic filter, carotid stents, avoidance of aortic atheroma) and nonsurgical measures (hypothermia, lumbar drain, management of mean arterial pressure, central venous pressure, cerebral perfusion pressure, pre- and postconditioning, and cerebral regional oxygenation monitoring, etc).

Multiple factors are associated with the incidence of POCD. Numerous pharmacological agents have been found to have certain degree of neuroprotective effects. Large-scale, randomized, multicenter clinical trials will be needed for the integration of these agents into our clinical practice.

Article Type
Review Article

Declaration of Interests
The authors have no conflicts of interest for this work to declare.

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