Canadian Journal of Anesthesia

, Volume 46, Supplement 5, pp R46–R56 | Cite as

The prevention and treatment of cerebral ischemia

  • William L. Lanier
Refresher Course Outline Track II

Summary

Although the major focus of recent cerebral protection research has been aimed at developing receptorspecific drugs, this effort has currently resulted in few improvements in patient outcome. Until advances in pharmacology translate to improvements in humans, the clinician and his patients will be well served by using more traditional techniques to prevent and treat cerebral ischemic events. This approach will involve interventions to a) identify patients who are experiencing or are at risk for developing cerebral ischemia, and b) alter systemic physiology in an attempt to lessen the duration and severity of any ischemic insults. Initial therapy should include interventions to improve cerebral perfusion and the oxygen carrying capacity of the blood. Once this is accomplished, measures should be taken to control blood glucose concentrations and treat fever. In otherwise stable surgical patients, mild reductions in patient temperature also may be of benefit, provided the temperature reductions do not introduce problems in systemic physiology and the patient is rewarmed prior to awakening from general anesthesia. General anesthetic choice may be of importance in controlling intracranial pressure and seizure activity; however, if direct cerebral protection is desired, the anesthetic of choice should be a barbiturate. Finally, in the patient at risk for cerebral vasospasm, nimodipine treatment should be considered. Collectively, these interventions should increase the patient’s chance for optimal neurologic recovery following ischemia.

La prévention et le traitement de l’ischémie cérébrale

Sommaire

Malgré que les recherches récentes centrées sur la protection cérébrales aient eu pour but de développer des médicaments spécifiques à des récepteurs, cet effort n’a actuellement rapporté que peu d’amélioration de l’évolution des patients. Jusqu’à ce que des progrès pharmacologiques permettent cette amélioration, le clinicien et ses patients seront bien servis par l’usage de techniques plus traditionnelles de prévention et de traitement des accidents ischémiques cérébraux. Cette démarche implique des interventions pour a) identifier les patients qui subissent ou qui sont à risque de subir une ischémie cérébrale, et b) changer la physiologie systémique dans une tentative de réduire la durée et la sévérité de tout accident ischémique. La thérapie initiale doit comprendre des interventions pour améliorer la perfusion cérébrale et la capacité de transport de l’oxygène sanguin. Une fois que cela est accompli, des mesures doivent être prises pour contrôler les concentrations de glucose sanguin et traiter la fièvre. Chez des opérés par ailleurs stables, des réductions légères de température peuvent être aussi bénéfiques, pourvu que les réductions de température n’introduisent pas de problèmes physiologiques systémiques et que le patient soit réchauffé avant le réveil, à la suite de l’anesthésie générale. Le choix de l’anesthétique général peut avoir son importance dans le contrôle de la pression intracrânienne et des crises convulsives; cependant, si une protection cérébrale directe est désirée, l’anesthésique de choix serait un barbiturique. Finalement, chez le patient à risque de vasospasme cérébral, le traitement à la nimodipine devrait être envisagé. Mises en commun, ces interventions devraient accroître les chances du patient pour une récupération neurologique optimale après l’ischémie.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • William L. Lanier
    • 1
  1. 1.Department of AnesthesiologyMayo ClinicRochesterUSA

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