Abstract
The “milieu interieur” or “internal environment” of the brain is determined by the glial cells, the cerebrospinal fluid, the blood-brain barrier, the cerebral blood flow, the central regulation of respiration, and the intracranial pressure. Anaesthetic agents and anoxia-ischaemic insult can disrupt this important but vulnerable neuronal environment. Head injury is used as an example of a common insult to the neuronal environment and the principles of management are discussed, using a model of brain physiology and pathophysiology which can be modified to include other clinical situations.
Summary
A model of the brain damaged by head injury has been presented as an example of a method of understanding the principles of pathophysiological and anaesthetic management of the stressed brain. The model may be expanded to include the anaesthetic management of the brain in patients with brain tumors,9,16 intracranial aneurysms,9,16 cerebrovascular occlusive disease,12 perinatal hypoxia,13,14 and acute problems such as cardiac arrest10 and near drowning.15
RéSUMé
Le milieu intérieur du cerveau est déterminé par les cellules gliales, le liquide céphalorachidien, la barrière hémato-encéphalique, le débit sanguin cérébral, le contrôle central de la respiration et la pression intra-crânienne. Les agents anesthésiques et l’agression anoxique et ischémique peuvent perturber cet environnement neuronal qui malgré son importance est trés vulnérable. Le traumatisme crânien est utilisé comme exemple d’un type fréquent d’agression subie par l’environnement neuronal et les principes de management en sont discutés en employant un modéle de physiologie cérébrale et de physiopathologie qui peut être modifié de façon à pouvoir faire face à d’autres situations cliniques.
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Wade, J.G. The “milieu interieur” — A model of brain physiology and pathophysiology. Canad. Anaesth. Soc. J. 27, 440–444 (1980). https://doi.org/10.1007/BF03007040
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DOI: https://doi.org/10.1007/BF03007040