Brain protection during cardiopulmonary bypass

I would like to share this information with you concerning optimization of cerebral outcome during CPB.

A part of today's SCA 34th Annual Meeting and workshops.

-Temperature
Monitor brain temperature
Avoid agressive rewarming
Avoid hyperthermia

-Avoid excessive hyperglycemia

-Reduce embolic load
Use alpha-stat ABG to avoid luxary CBF (Patel et al. J Thorac Cardiovasc Surg 1996;111:1267-79)
CO2 insufflation
Minimize cardiotomy use (cell saver) (Dgaiani G et al. Circulation 2007;116-1888-1895)

-Atheroma management
Epiaortic scanning
Minimize aortic manipulation

-Off-Pump Coronary Artery Bypass -- No reduction in stroke

-Drugs -- Little evidence for efficacy

-CNS monitoring: BIS/EEG, Temperature, MAP/CVP,
Cerebral Oximetry

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