Brain Injury and Protection During Heart Surgery

Glucose, insulin and potassium for heart protection during cardiac surgery.

BACKGROUND Coronary artery bypass grafting with hypothermic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. Our study investigated whether an infusion of glucose, insulin and potassium (GIK) during elective coronary artery bypass surgery decreases myocardial cell death. METHODS We measured cardiac troponin I (cTnI), a myofibrillar structural protein, whic...

Protection Against Traumatic Brain Injury

Brain protection during neurosurgery.

The initial concept of brain protection during neurosurgery is based on research done in the 1970s-1980 which established the concept that by decreasing cerebral metabolic rate the brain could survive longer periods of ischemia. The first section of this chapter reviews some of this initial research that promoted the use of barbiturates for cerebral protection. The second section reviews curren...

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

BACKGROUND Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographi...

Cerebral Protection During Cardiac Surgery

Despite many advances in perioperative care, cerebral injury from cardiac surgery remains an important source of patient morbidity and mortality. This injury has a range of clinical manifestations, including stroke and encephalopathy, which occur in 1–3% and 10–15% of patients, respectively. Postoperative cognitive dysfunction (POCD) is more common, affecting 15–40% of patients 1 month after su...