Abstract
CEREBRAL ISCHEMIA/HYPOXIA may occur in a variety of perioperative circumstances. The main pathophysiologic aspects involved in cerebral ischemia/reperfusion are caused by adenosine triphosphate (ATP) consumption, the excitotoxic actions of glutamate, changes in ionic homeostasis, and formation of free radicals (Fig 1). Outcomes from such events range from subclinical neurocognitive deficits to catastrophic neurologic morbidity or death. 1 Fukuda S. Warner D.S. Cerebral protection. Br J Anaesth. 2007; 99: 10-17 Crossref PubMed Scopus (71) Google Scholar Stroke is a severe complication that occurs rarely, perioperatively, but when it happens, stroke is associated with a high mortality or results in serious disability. Also, because of limited options, stroke is difficult to treat. Carotid endarterectomy (CEA) is an essential part of stroke-prevention strategies but the incidence of perioperative stroke during CEA is approximately 2.3%. 2 Brott T.G. Hobson 2nd, R.W. Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010; 363: 11-23 Crossref PubMed Scopus (2254) Google Scholar In recent decades, there have been intense investigations of general anesthesia-induced neuroprotection. It would be of great clinical significance if general anesthetics could provide therapeutic benefit in the event of ischemia, hypoxia, or any kind of brain lesions (reperfusion and oxygen-glucose deprivation). 3 Vutskits L: General anesthetics in brain injury:Friends or foes? Curr Pharm Des 2013 Sep 10 [Epub ahead of print] Google Scholar , 4 Michenfelder J.D. Sundt T.M. Fode N. et al. Isoflurane when compared to enflurane and halothane decreases the frequency of cerebral ischemia during carotid endarterectomy. Anesthesiology. 1987; 67: 336-340 Crossref PubMed Scopus (122) Google Scholar , 5 Zuo Z. Tichotsky A. Johns R.A. Inhibition of excitatory neurotransmitter-nitric oxide signaling pathway by inhalational anesthetics. Neuroscience. 1999; 93: 1167-1172 Crossref PubMed Scopus (28) Google Scholar , 6 Wei H. Inan S. Dual effects of neuroprotection and neurotoxicity by general anesthetics: Role of intracellular calcium homeostasis. Prog Neuropsychopharmacol Biol Psychiatry. 2013; 47: 156-161 Crossref PubMed Scopus (30) Google Scholar The main focus of this article is to describe the concept of anesthetic preconditioning, as well as postconditioning, and to summarize the most recent discoveries in this field.
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