Summary
A functional classification of hypoxia of the brain has been presented and some of its significant aspects have been discussed. Mechanisms of protection from hypoxia of the brain were reviewed under the headings of prevention, hyperventilation, hypothermia and protection by barbiturates.
In prevention of hypoxia of the brain, avoidance of factors producing a fall in cerebral perfusing pressure was emphasized. Hyperventilation is not advised unless one can readily measure regional cerebral blood flow. In the operating room, normocarbia or slight hypocarbia is recommended.
Animal studies indicate a protective role of barbiturates in ischaemic hypoxia of the brain. However, it should be emphasized that, at present, hypothermia is the only established means of protection against hypoxia of the brain in man, when it is induced prior to the hypoxic insult. The evidence for protection by barbiturates has been found only in experimental animals. If one can extrapolate the results of studies in animals to man, then potential benefits would be expected in clinical stroke, cardiac arrest, in operations on the carotid artery and in head injury.
Résumé
Les auteurs présentent une classification fonctionnelle de ľhypoxie cérébrale et en discutent certains aspects importants. Les mécanismes de protection du cerveau contre ľhypoxie sont étudiés en relation avec la prévention, ľhyperventilation, ľhypothermie et les effets des barbituriques.
Dans la prévention de ľhypoxie cérébrale, il est important ďéviter une baisse de la pression de perfusion. Ľhyperventilation est à déconseiller à moins que la mesure du débit sanguin régional ne soit disponible. En salle ďopération, on recommande la normocapnie ou une légère hypocapnie.
Des études sur les animaux ont montré le rôle protecteur joué par les barbituriques dans ľischémie hypoxique. Cependant, il faut insister sur le fait que, jusqu’à maintenant, ľhypothermie, lorsqu’elle précède ľagression hypoxique, est le moyen reconnu de protection pour le cerveau. Ľeffet bénéfique des barbituriques n’a été démontré que chez ľanimal de laboratoire. Si on applique ces résultats à ľhumain, on peut s’attendre à ce que le traitement aux barbituriques soit utile dans ľaccident cérébro-vasculaire, ľarrêt cardiaque, la chirurgie de la carotide et le traumatisme crânien.
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Ping, F.C., Jenkins, L.C. Protection of the brain from hypoxia: A review. Canad. Anaesth. Soc. J. 25, 468–473 (1978). https://doi.org/10.1007/BF03007408
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DOI: https://doi.org/10.1007/BF03007408