Brain Protection in Cardiac Surgery Volume 1
Brain injury remains one of the most dreaded complications of cardiac surgery. The range of injury is broad; while a stroke may be easily defined and diagnosed, more subtle injuries most definitely occur. There remains debate as to how these are diagnosed
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Robert S. Bonser • Domenico Pagano Axel Haverich (Editors)
Brain Protection in Cardiac Surgery
Prof. Robert S. Bonser MD, FRCP, FRCS, FESC, FACC Professor and Consultant Cardiac Surgeon Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK Mr. Domenico Pagano Cardiothoracic Surgery Beaumont Road 208 B30 1NX Birmingham Bournville United Kingdom
Prof. Axel Haverich Medizinische Hochschule Hannover (MHH) Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie Carl-Neuberg-Str. 1 30625 Hannover Germany
ISBN: 978-1-84996-292-6 e-ISBN: 978-1-84996-293-3 DOI: 10.1007/978-1-84996-293-3 A catalogue record for this book is available from the British Library Library of Congress Control Number: 2010937962 © Springer-Verlag London Limited 2011 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Printed on acid-free paper Springer Science+Business Media (www.springer.com)
Foreword
“You are old, Father William,” the young man said, And your hair has become very white; And yet you incessantly stand on your head – Do you think, at your age, it is right?” “In my youth,” Father William replied to his son, I feared it might injure the brain; But, now that I’m perfectly sure I have none, Why, I do it again and again.”1 These verses from the poem Father William1 were composed by Lewis Carroll, the author of Alice’s Adventures in Wonderland. They suggest that brain damage might be induced by serial insults – albeit in this case, by standing on one’s head! The recognition that cardiac surgical operations might be associated with brain injury was reported by Fox et al. in 1954,2 the very year in which Gibbon reported the first successful clinical use of the heart-lung machine in cardiac surgery.3 Succeeding years saw numerous studies confirming the association between cardiac surgery and cerebral injury. Although much research effort has been expended over the years, brain damage in cardiac surgical patients remains a significant and challenging problem, not least because of the increased susceptibi
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