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Neuroanesthesia pp 345–369Cite as

Intraoperative Pharmacologic Brain Protection

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Part of the book series: Developments in Critical Care Medicine and Anesthesiology ((DCCA,volume 32))

Abstract

This chapter provides a discussion of the use of pharmacologic agents and induced hypothermia to increase the brain’s tolerance to intraoperative ischemia. As necessary background, the reader should appreciate that there are two types of ischemic insult: focal and global. Therapies effective for one type are not necessarily effective for the other.

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References

  1. Maekawa T, McDowall DG, Okuda Y: Brain-surface oxygen tension and cerebral cortical blood flow during hemorrhagic and drug-induced hypotension in the cat. Anesthesiology 51:313–320, 1979

    Article  PubMed  CAS  Google Scholar 

  2. Feustel PJ, Ingvar MC, Severinghaus JW: Cerebral oxygen availability and blood flow during middle cerebral artery occlusion: Effects of pentobarbital. Stroke 12:858–863, 1981

    Article  PubMed  CAS  Google Scholar 

  3. Todd MM, Warner DS: A comfortable hypothesis re-evaluated: cerebral metabolic rate depression and brain protection during ischemia [Editorial]. Anesthesiology 76:161–4, 1992

    Article  PubMed  CAS  Google Scholar 

  4. Zhao Q, Memezawa H, Smith ML, Siesjo BK: Hyperthermia complicates middle cerebral artery occlusion induced by an intraluminal filament. Brain Res 649:1994

    Google Scholar 

  5. Warner DS, Todd MM, McFarlane C, et al: Sevoflurane and halo-thane reduce focal ischemic brain damage in the rat: Possible influence on thermoregulation. Anesthesiology 79:985–92, 1993

    Article  PubMed  CAS  Google Scholar 

  6. Hoffman WE, Cheng MA, Thomas C, Baughman VL, Albrecht RF: Clonidine decreases plasma catecholamines and improves outcome from incomplete ischemia in the rat. Anesth Analg 73:460–464, 1991

    PubMed  CAS  Google Scholar 

  7. Werner C, Hoffman WE, Thomas C, Miletich DJ, Albrecht RF: Ganglionic blockade improves neurologic outcome from incomplete ischemia in rats: partial reversal by exogenous catecholamines. Anesthesiology 73:923–9, 1990

    Article  PubMed  CAS  Google Scholar 

  8. Smith-Swintosky VL, Pettigrew LC, Sapolsky RM, et al: Metyrapone, an inhibitor of glucocorticoid production, reduces brain injury induced by focal and global ischemia and seizures. J Cereb Blood Flow and Metabol 16:585–98, 1996

    Article  CAS  Google Scholar 

  9. Smith AL, Hoff JT, Nielsen SL, Larson CP: Barbiturate protection in acute focal cerebral ischemia. Stroke 5:1–7, 1974

    Article  PubMed  CAS  Google Scholar 

  10. Hoff JT, Smith AL, Hankinson HL, Nielsen SL: Barbiturate protection from cerebral infarction in primates. Stroke 6:28–33, 1975

    Article  PubMed  CAS  Google Scholar 

  11. Michenfelder JD, Milde JH, Sundt TM: Cerebral protection by barbiturate anesthesia. Use after middle cerebral artery occlusion in Java monkeys. Arch Neurol 33:345–350, 1976

    Article  PubMed  CAS  Google Scholar 

  12. Lawner PM, Laurent JP, Simeone FA, Fink EA: Effect of extracranialintracranial bypass and pentobarbital on acute stroke in dogs. J Neurosurg 56:92–96, 1982

    Article  PubMed  CAS  Google Scholar 

  13. Selman WR, Spetzler RF, Roski RA, et al: Barbiturate coma in focal cerebral ischemia. Relationship of protection to timing of therapy. J Neurosurg 56:685–690, 1982

    Article  PubMed  CAS  Google Scholar 

  14. Hoff JT, Nishimura M, Newfield P: Pentobarbital protection from cerebral infarction without suppression of edema. Stroke 13:623–628, 1982

    Article  PubMed  CAS  Google Scholar 

  15. Nehls DG, Todd MM, Spetzler RF, et al: A comparison of the cerebral protective effects of isoflurane and barbiturates during temporary focal ischemia in primates. Anesthesiology 66:453–464, 1987

    Article  PubMed  CAS  Google Scholar 

  16. Corbett D, Evans S, Thomas C, et al: MK-801 reduced cerebral ischemic injury by inducing hypothermia. Brain Res 514:300–304, 1990

    Article  PubMed  CAS  Google Scholar 

  17. Warner DS, Zhou J, Ramani R, Todd MM: Reversible focal ischemia in the rat: Effects of halothane, isoflurane, and methohexital anesthesia. J Cereb Blood Flow Metabol 11:794–802, 1991

    Article  CAS  Google Scholar 

  18. Drummond JC, Cole DJ, Patel PM, Reynolds LW: Focal cerebral ischemia during anesthesia with etomidate, isoflurane or thiopental: A comparison of the extent of cerebral injury. Neurosurgery 37:742–9, 1995

    Article  PubMed  CAS  Google Scholar 

  19. Cole DJ, Drummond JC, Ghazal EA, Shapiro HM: A reversible component of cerebral injury as identified by the histochemical stain 2, 3, 5-triphenyltetrazolium chloride (TTC). Acta Neuropathol 80:152–155, 1990

    Article  PubMed  CAS  Google Scholar 

  20. Michenfelder J: The interdependency of cerebral function and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 41:231–236, 1974

    Article  PubMed  CAS  Google Scholar 

  21. Warner DS, Takaoka S, Wu B, et al: Electroencephalographic burst suppression is not required to elicit maximal neuroprotection from pentobarbital in a rat model of focal cerebral ischemia. Anesthesiology 84:1475–84, 1996

    Article  PubMed  CAS  Google Scholar 

  22. Nussmeier NA, Arlund C, Slogoff S: Neuropsychiatric complications after cardiopulmonary bypass: Cerebral protection by a barbiturate. Anesthesiology 64:165–170, 1986

    Article  PubMed  CAS  Google Scholar 

  23. Zaidan JR, Klochany A, Martin WM, et al: Effect of thiopental on neurologic outcome following coronary artery bypass grafting. Anesthesiology 74:406–411, 1991

    Article  PubMed  CAS  Google Scholar 

  24. Barbut D, Hinton RB, Szatrowski TP: Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 25:2398–2402,1994

    Article  PubMed  CAS  Google Scholar 

  25. Stump DA, Rogers AT, Kon ND, et al: When emboli occur during coronary artery bypass graft surgery. Anesth 79:A49, 1993

    Article  Google Scholar 

  26. Michenfelder JD, Sundt TM, Fode N, Sharbrough FW: Isoflurane when compared to enflurane and halothane decreases the frequency of cerebral ischemia during carotid endarterectomy. Anesthesiology 67:336–340, 1987

    Article  PubMed  CAS  Google Scholar 

  27. Gelb AW, Boisvert DP, Tang C, et al: Primate brain tolerance to temporary focal cerebral ischemia during isoflurane-or sodium nitroprusside-induced hypotension. Anesthesiology 70:678–683, 1989

    Article  PubMed  CAS  Google Scholar 

  28. Warner DS, Desphande JK, Wieloch T: The effect of isoflurane on neuronal necrosis following near-complete forebrain ischemia in the rat. Anesthesiology 64:19–23, 1986

    Article  PubMed  CAS  Google Scholar 

  29. Baughman VL, Hoffman WE, Miletich DJ, et al: Neurologic outcome in rats following incomplete cerebral ischemia during halothane, isoflurane, or N2O. Anesthesiology 69:192–198, 1988

    Article  PubMed  CAS  Google Scholar 

  30. Milde LN, Milde JH, Lanier WL, et al: Comparison of the effects of isoflurane and thiopental on neurologic outcome and neuropathology after temporary focal cerebral ischemia in primates. Anesthesiology 69:905–913, 1988

    Article  PubMed  CAS  Google Scholar 

  31. Ruta TS, Drummond JC, Cole DJ: A comparison of the area of histochemical dysfunction after focal cerebral ischaemia during anaesthesia with isoflurane and halothane in the rat. Can J Anaesth 38:129–135,1991

    Article  PubMed  CAS  Google Scholar 

  32. Sano T, Drummond JC, Patel PM, et al: A comparison of the cerebral protective effects of isoflurane and mild hypothermia in a model of incomplete forebrain ischemia in the rat. Anesthesiology 76:221–228, 1992

    Article  PubMed  CAS  Google Scholar 

  33. Hoffman WE, Thomas C, Albrecht RF: The effect of halothane and isoflurane on neurologic outcome following incomplete cerebral ischemia in the rat. Anesth Analg 76:279–283, 1993

    Article  PubMed  CAS  Google Scholar 

  34. Ravussin P, deTribolet N: Total intravenous anesthesia with propofol for burst suppression in cerebral aneurysm surgery: Preliminary report of 42 patients. Neurosurgery 32:236–240, 1993

    Article  PubMed  CAS  Google Scholar 

  35. Ridenour TR, Warner DS, Todd MM, Glonet TX: Comparative effects of propofol and halothane on outcome from temporary middle cerebral artery occlusion in the rat. Anesthesiology 76:807–812, 1992

    Article  PubMed  CAS  Google Scholar 

  36. Batjer HH, Frankfurt AI, Purdy PD, et al: Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:234–240, 1988

    Article  PubMed  CAS  Google Scholar 

  37. Watson JC, Drummond JC, Patel PM, et al: An assessment of the cerebral protective effects of etomidate in a model of incomplete forebrain ischemia in the rat. Neurosurgery 30:540–4, 1992

    Article  PubMed  CAS  Google Scholar 

  38. Sano T, Patel PM, Drummond JC, Cole DJ: A comparison of the cerebral protective effects of etomidate, thiopental and isoflurane in a model of forebrain ischemia in the rat. Anesth Analg 76:990–7, 1993

    Article  PubMed  CAS  Google Scholar 

  39. Nebauer AE, Doenicke A, Hoernecke R, Angster R, Mayer M: Does etomidate cause haemolysis? Br J Anaesth 69:58–60, 1992

    Article  PubMed  CAS  Google Scholar 

  40. Wolff DJ, Datto GA, Samatovicz RA, Tempsick RA: Calmodulindependent nitric-oxide synthase. Mechanism of inhibition by imidazole and phenylimidazoles. J Biol Chem 268:9425–9, 1993

    PubMed  CAS  Google Scholar 

  41. Church J, Zeman S, Lodge D: The neuroprotective action of ketamine and MK-801 after transient cerebral ischemia in rats. Anesthesiology 69:702–709, 1988

    Article  PubMed  CAS  Google Scholar 

  42. Hoffman WE, Pelligrino DA, Albrecht RF: Ketamine, an NMDA antagonist, improves outcome from incomplete cerebral ischemia in rats. Anesthesiology 75:A605 (Abstract), 1991

    Google Scholar 

  43. Steinberg GK, Saleh J, Kunis D, DeLaPaz R, Zarnegar SR: Protective effect of N-methyl-D-aspartate antagonists after focal cerebral ischemia in rabbits. Stroke 20:1247–1252, 1989

    Article  PubMed  CAS  Google Scholar 

  44. Albers GW, Saenz RE, Moses JA, Choi DW: Safety and tolerance of oral dextromethorphan in patients at risk for brain ischemia. Stroke 22:1075–1077, 1991

    Article  PubMed  CAS  Google Scholar 

  45. Hoffman WE, Kochs E, Werner C, Thomas C, Albrecht RF: Dexmedetomidine improves neurologic outcome from incomplete ischemia in the rat. Anesthesiology 75:328–332, 1991

    Article  PubMed  CAS  Google Scholar 

  46. Kassell NF, Haley EC, Apperson-Hansen C, et al: Randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in Europe, Australia, and New Zealand. J Neurosurg 84:221–8, 1996

    Article  PubMed  CAS  Google Scholar 

  47. Bracken MB, Shepard MJ, Collins WF: A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the second National Acute Spinal Cord Injury Study. N Engl J Med 322:1405–1411, 1990

    Article  PubMed  CAS  Google Scholar 

  48. Seki H, Yoshimoto T, Ogawa A, Suzuki J: Effect of mannitol on rCBF in canine thalamic ischemia - an experimental study. Stroke 14:46–50, 1983

    Article  PubMed  CAS  Google Scholar 

  49. Jafar JJ, Johns LM, Mullan SF: The effect of mannitol on cerebral blood flow. J Neurosurg 64:754–759, 1986

    Article  PubMed  CAS  Google Scholar 

  50. Meyer FB, Anderson RE, Sundt TM, Yaksh TL: Treatment of experimental focal cerebral ischemia with mannitol. J Neurosurg 66:109–115,1987

    Article  PubMed  CAS  Google Scholar 

  51. Shirane R, Weinstein PR: Effect of mannitol on local cerebral blood flow after temporary complete cerebral ischemia in rats. J Neurosurg 76:486–492, 1992

    Article  PubMed  CAS  Google Scholar 

  52. Suzuki J, Takahashi A, Yoshimoto T, Seki H: Use of balloon occlusion and substances to protect ischemic brain during resection of posterior fossa AVM. J Neurosurg 63:626–629, 1985

    Article  PubMed  CAS  Google Scholar 

  53. Fisher M, Bogousslaysky J: A glimmer of hope for acute ischemic stroke. Cerebrovasc Dis 4:177–8, 1994

    Article  Google Scholar 

  54. Pickard JD, Murray GD, Illingworth R, et al: Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. Br Med J 298:636–642, 1989

    Article  CAS  Google Scholar 

  55. Franke CL, Palm R, Dalby M, et al: Flunarizine in stroke treatment (FIST): a double-blind, placebo-controlled trial in Scandinavia and the Netherlands. Acta Neurol Scand 93:56–60, 1996

    Article  PubMed  CAS  Google Scholar 

  56. Haley EC, Kassell NF, Torner JC, et al: A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage: A report of the Cooperative Aneurysm Study. J Neurosurg 78:537–47, 1993

    Article  PubMed  Google Scholar 

  57. Wahlgren NG, MacMahon OG, DeKeyser J, et al: Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischemic stroke. Cerebrovasc Dis 4:204–210, 1994

    Article  Google Scholar 

  58. Legault C, Furberg CD, Wagenknecht LE, et al: Nimodipine neuroprotection in cardiac valve replacement. Report of an early terminated trial. Stroke 27:593–598, 1996

    Article  PubMed  CAS  Google Scholar 

  59. Roine RO, Kaste M, Kinnunen A, et al: Nimodipine after resuscitation from out-of-hospital ventricular fibrillation: A placebo-controlled, double-blind, randomized trial. JAMA 264:3171–3177, 1990

    Article  PubMed  CAS  Google Scholar 

  60. Brain Resuscitation Clinical Trial II Study Group. A randomized clinical study of a calcium-entry blocker (Lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 324:1225–31, 1991

    Article  Google Scholar 

  61. Busto R, Dietrich WD, Globus MY-T, et al: Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 7:729–738, 1987

    Article  PubMed  CAS  Google Scholar 

  62. Busto R, Globus MY-T, Dietrich WD, et al: Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 20:904–910, 1989

    Article  PubMed  CAS  Google Scholar 

  63. Minamisawa H, Smith M-L, Siesjö BK: The effect of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia. Ann Neurol 28:26–33, 1990

    Article  PubMed  CAS  Google Scholar 

  64. Welsh FA, Sims RE, Harris VA: Mild hypothermia prevents ischemic injury in gerbil hippocampus. J Cereb Blood Flow Metab 10:557–563, 1990

    Article  PubMed  CAS  Google Scholar 

  65. Ridenour TR, Warner DS, Todd MM, McAllister AC: Mild hypothermia reduces infarct size resulting from temporary but not permanent focal ischemia in rats. Stroke 23:733–738, 1992

    Article  PubMed  CAS  Google Scholar 

  66. Coimbra C, Wieloch T: Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 87:325–31, 1994

    Article  PubMed  CAS  Google Scholar 

  67. Buchan A, Pulsinelli WA: Hypothermia but not the N-Methyl-DAspartate antagonist, MK-801, attenuates neuronal damage in gerbils subjected to transient global ischemia. J Neurosci 10:311–316, 1990

    PubMed  CAS  Google Scholar 

  68. Boris-Möller F, Smith M-L, Siesjö BK: Effects of hypothermia on ischemic brain damage: A comparison between preischemic and postischemia cooling. Neurosci Res Com 5:87–94, 1989

    Google Scholar 

  69. Busto R, Dietrich WD, Globus MY-T, Ginsberg MD: Post-ischemic moderate hypothermia inhibits CA1 hippocampal neuronal ischemic injury. Neurosci Lett 101:299–304, 1989

    Article  PubMed  CAS  Google Scholar 

  70. Baker CJ, Onesti MT, Solomon RA: Reduction by delayed hypothermia of cerebral infarction following middle cerebral artery occlusion in the rat: A time-course study. J Neurosurg 77:438–44, 1992

    Article  PubMed  CAS  Google Scholar 

  71. Marion DW, Obrist WD, Carlier PM, et al: The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 79:354–362, 1993

    Article  PubMed  CAS  Google Scholar 

  72. Shiozaki T, Sugimoto H, Taneda M, et al: Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 79:363–368, 1993

    Article  PubMed  CAS  Google Scholar 

  73. Clifton GL, Allen S, Barrodale P, et al: A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 10:263–73, 1993

    Article  PubMed  CAS  Google Scholar 

  74. Maher J, Hachinski V: Hypothermia as a potential treatment for cerebral ischemia. Cerebrovasc Brain Metab Rev 5:277–300, 1993

    PubMed  CAS  Google Scholar 

  75. Michenfelder JD: Anesthesia and the brain: Clinical, functional, metabolic, and vascular correlates. New York, Churchill Livingstone Inc., 1988

    Google Scholar 

  76. Nemoto E, Yonas H, Klementavicus R: Components of brain oxygen metabolism in rats and its relevance to ischemic injury. Anesth Ana1g 80:S342, 1995

    Google Scholar 

  77. Nakashima K, Todd MM: Effects of hypothermia, pentobarbirtal, and isoflurane on postdepolarization amino acid release during complete global cerebral ischemia. Anesthesiology 85:161–168, 1996

    Article  PubMed  CAS  Google Scholar 

  78. Patel PM, Drummond JC, Cole DJ, Yaksh TL: Differential temperature sensitivity of ischemia-induced glutamate release and eicosanoid production in rats. Brain Res 650:205–222, 1994

    Article  PubMed  CAS  Google Scholar 

  79. Nakashima K, Todd MM: Effects of hypothermia on the rate of excitatory amino acid release after ischemic depolarization. Stroke 27:913–918, 1996

    Article  PubMed  CAS  Google Scholar 

  80. Globus MY, Busto R, Lin B, et al: Detection of free radical activity during transient global ischemia and recirculation: Effects of intraischemic brain temperature modulation. J Neurochem 65:1250–1256, 1995

    Article  PubMed  CAS  Google Scholar 

  81. Globus MY, Alonso O, Dietrich WD, et al: Glutamate release and free radical production following brain injury: Effects of posttraumatic hypothermia. J Neurochem 65:1704–1711, 1995

    Article  PubMed  CAS  Google Scholar 

  82. Kil HY, Zhang J, Piantadosi CA: Brain temperature alters hydroxyl radical production during cerebral ischemia/reperfusion in rats. J Cereb Blood Flow Metabol 16:100–106, 1996

    CAS  Google Scholar 

  83. Huang K: The mechanism of protein kinase C activation. TINS 12:425–432, 1989

    PubMed  CAS  Google Scholar 

  84. Cardell M, Bingren H, Wieloch T, et al: Protein kinase C is translocated to cell membranes during cerebral ischemia. Neurosci Lett 119:228–232, 1990

    Article  PubMed  CAS  Google Scholar 

  85. Hara K, Onodera H, Yoshidomi M, et al: Staurosporine, a novel protein kinase C inhibitor, prevents postischemic neuronal damage in the gerbil and rat. J Cereb Blood Flow Metab 10:646–653, 1990

    Article  PubMed  CAS  Google Scholar 

  86. Hanson SK, Grotta JC, Waxman MN, et al: Calcium/calmodulindependent protein kinase II activity in focal ischemia with reperfusion in rats. Stroke 25:466–473, 1994

    Article  PubMed  CAS  Google Scholar 

  87. Churn SB, Taft WC, Billingsley MS, et al: Temperature modulation of ischemic neuronal death and inhibition of calcium/calmodulindependent protein kinase II in gerbils. Stroke 21:1715–1721, 1990

    Article  PubMed  CAS  Google Scholar 

  88. Picone CM, Grotta JC, Earls R, et al: Immunohistochemical determination of calcium-calmodulin binding predicts neuronal damage after global ischemia. J Cereb Blood Flow Metab 9:805–811, 1989

    Article  PubMed  CAS  Google Scholar 

  89. Yamashita K, Eguchi U, Kajiwara K, Ito H: Mild hypothermia ameliorates ubiquitin synthesis and prevents delayed neuronal death in the gerbil hippocampus. Stroke 22:1574–1581, 1991

    Article  PubMed  CAS  Google Scholar 

  90. Baker KZ, Young WL, Stone JG, et al: Deliberate mild intraoperative hypothermia for craniotomy. Anesthesiology 81:361–367, 1994

    Article  PubMed  CAS  Google Scholar 

  91. Mariak Z, Lewko J, Luczaj J, et al: The relationship between directly measured human cerebral and tympanic temperatures during changes in brain temperatures. Eur J Appl Physiol 69:545–549, 1994

    Article  CAS  Google Scholar 

  92. Stone JG, Young WL, Smith CR, et al: Do standard monitoring sites reflect true brain temperature when profound hypothermia is rapidly induced and reversed? Anesthesiology 82:344–351, 1995

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. John C. Drummond MD, FRCPC
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Editors and Affiliations

  1. Department of Anesthesiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA

    J. O. Johnson MD, PhD , R. J. Sperry MD, PhD  & T. H. Stanley ,  & 

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Drummond, J.C. (1997). Intraoperative Pharmacologic Brain Protection. In: Johnson, J.O., Sperry, R.J., Stanley, T.H. (eds) Neuroanesthesia. Developments in Critical Care Medicine and Anesthesiology, vol 32. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5774-2_28

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  • DOI: https://doi.org/10.1007/978-94-011-5774-2_28

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