Abstract
Open-heart surgery is the leading cause of neuronal injury in the perioperative state, with some patients complicating with cerebrovascular accidents and delirium. Neurological fallout places an immense burden on the psychological well-being of the person affected, their family, and the healthcare system. Several randomised control trials (RCTs) have attempted to identify therapeutic and interventional strategies that reduce the morbidity and mortality rate in patients that experience perioperative neurological complications. However, there is still no consensus on the best strategy that yields improved patient outcomes, such that standardised neuroprotection protocols do not exist in a significant number of anaesthesia departments. This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes. Furthermore, a summary of existing RCTs and large observational studies are examined to determine which strategies are supported by science and which lack definitive evidence. We have established that the overall evidence for pharmacological neuroprotection is weak. Most neuroprotective strategies are based on animal studies, which cannot be fully extrapolated to the human population, and there is still no consensus on the optimal neuroprotective strategies for patients undergoing cardiac surgery. Large multicenter studies using universal standardised neurological fallout definitions are still required to evaluate the beneficial effects of the existing neuroprotective techniques.
Highlights
Neuroprotection encompasses strategies that preserve neuronal structure and function
This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes
Better outcomes were in younger patients, male gender, more prolonged cardio-pulmonary bypass (CPB), and higher concentrations of lidocaine
Summary
Neuroprotection encompasses strategies that preserve neuronal structure and function. Neurological fallout must be prevented in all patients undergoing any form of surgery, those referred for cardiac surgery. In a study involving 10,250 patients that underwent cardiac surgery, 221 (2%) experienced a postoperative stroke, and the duration of hospitalisation was significantly longer in these patients compared to those without postoperative stroke (10 vs 16 days, p < 0.001) [1]. Numerous randomised controlled trials (RCTs) have investigated the efficacy of pharmacological and non-pharmacological interventions that reduce neurological injury during and after cardiac surgery [2,3,4]. There is still controversy on the optimal neuroprotection strategy that leads to better patient outcomes. This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes
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