Brain Injury and Protection During Heart Surgery

1. Front Matter

   Pages i-xiii

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2. Cerebral Injury During Open Heart Surgery: Studies Using Functional, Biochemical, and Morphological Methods

   • Torkel Åberg

   Pages 1-12

3. Neurological Outcome After ‘Low Flow Low Pressure’ Cardiopulmonary Bypass

   • Frank H. Sarnquist

   Pages 13-25

4. Cerebral Blood Flow: Autoregulation During Cardiopulmonary Bypass

   • Ann V. Govier, J. G. Reves

   Pages 27-45

5. Cerebral Hyperperfusion During Cardiopulmonary Bypass: The Influence of PaCO2

   • John M. Murkin

   Pages 47-66

6. Microembolization: Etiology and Prevention

   • Kevin J. Fish

   Pages 67-83

7. Macroembolization: Prevention and Outcome Modification

   • Nancy A. Nussmeier, John P. McDermott

   Pages 85-107

8. Tools for Assessing Central Nervous System Injury in the Cardiac Surgery Patient

   • G. Bashein, Stephen W. Bledsoe, Brenda D. Townes, David B. Coppel

   Pages 109-135

9. Perfusion Techniques that may Decrease Brain Injury During Cardiopulmonary Bypass

   • Richard G. Berryessa, Charles M. Tyndal Jr.

   Pages 137-156

10. Brain Function after Hypothermic Circulatory Arrest

    • Deborah Mitchell, Mark Hilberman

    Pages 157-170

11. Back Matter

    Pages 171-173

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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.

• Bypass
• Nervous System
• brain
• brain injury
• complications
• heart
• prevention

`The reduction of the celebral complications of cardiac surgery is undoubtly going to be of increasing importance both medically and legally over the next five years and this book is a valuable contribution within the subject.'
Perfusion
`The book is recommended to those whose practice includes cardiopulmonary bypass as a reference and to those who are seeking an introduction to the spectrum of neuropsychiatric complications encountered after cardiac surgery, and what can be done to minimize their incidence.'
Chest, July 1990

• University of Colorado, Denver, USA

  Mark Hilberman

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