NEUROANESTHESIA: Edited by Ramachandran RamaniProtecting the brain during neurosurgical procedures strategies that can workEl Beheiry, Hossama,b Author Information aDepartment of Anaesthesia, Trillium Health Centre, Mississauga bUniversity of Toronto, Toronto, Ontario, Canada Correspondence to Hossam El Beheiry, MBBCh, PhD, FRCPC, Trillium Health Centre, 100 Queensway West, Mississauga, Ontario, Canada. Tel: +1 905 848 7628; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2012 - Volume 25 - Issue 5 - p 548-555 doi: 10.1097/ACO.0b013e3283579622 Buy Metrics Abstract Purpose of review The quest for neuroprotection strategies during periods of neuronal vulnerability persists despite decades of basic and clinical research. This review will focus on the latest developments in the area of clinical brain protection with the major emphasis on strategies that can be beneficial during neurosurgical procedures. Recent findings Brain protection in neurosurgical patients may be achieved by nonpharmacological and pharmacological strategies. Pharmacological neuroprotection including anaesthetic administration have not been recently shown to be successful. Alternatively, nonpharmacological strategies including maintenance of cerebral perfusion by adequate control of mean arterial pressure (≥80 mmHg), liberal normoglycaemia (7.8–10 mmol/l), adequate haemoglobin levels (preoperative ≥120 g/l and intraoperative ≥90 g/l) and induction of hypertension (20–40% of preoperative values) in certain neurosurgical situations can be beneficial as neuroprotectants during neurosurgery. Mild hypothermia (32–35°C) failed to achieve neuroprotective effects in several situations of brain injury. Summary The findings of this review suggest that the anaesthesiologist is compelled to use nonpharmacological strategies sometimes based on empiric evidence to protect the brain during neurosurgical procedures. These strategies are simple, have high benefit/risk ratios and are inexpensive. Rigorous controlled clinical studies are needed to investigate the neuroprotective efficacy of these commonly used nonpharmacological methods. © 2012 Lippincott Williams & Wilkins, Inc.