Abstract
Although postoperative neurologic dysfunction occurs in 10∼70% of all patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB), a universally accepted perioperative cerebral management strategy for reducing the risk of neurological injury has yet to be established. This paper reviews perioperative cerebral management before, during and after surgery. Risk factors for adverse neurological and neuropsychological outcomes should be identified, if possible, during the preoperative period, and preoperative physical and pharmacological neuroprotective strategies should be developed for patients found to be ‘at risk’. The detection of mobile atheromatous plaques in the ascending aorta during surgery is the single most important contributing factor to perioperative neurological morbidity. Significant increases in cerebral temperature can aggravate ischemic neuronal injury and accelerate neuronal death. Therefore, the cooling phase during CPB should be adequate, and the rewarming phase must be carefully managed. Postoperative hyperthermia is correlated with a higher degree of cognitive dysfunction after cardiac surgery. Cardiac anesthesiologists and intensive care physicians can reduce the risk of inadvertent hyperthermia, and in some cases, induce the beneficial effects of hypothermia, of which adverse effects are preventable in an intensive care setting, by continuously monitoring body temperature during the postoperative period.
