BRAIN PROTECTION AND RELAXATION IN THE OP ERATING-ROOM

Cerebral protection combines techniques aimed 1) to avoid death of neu rones which sustained primary ischemic of traumatic insults and 2) to prevent secondary insults to the brain. The chemical brain retractor c oncept includes the use of a total intravenous anesthesia technique, m ild hypocapnia and mannitol with strict monitoring and maintenance of the global cerebral homeostasis. This contributes to decrease brain vo lume and intracranial pressure and allows the best possible access to the operating site, while avoiding excessive pressure under the surgic al brain retractors. Neuronal protection is based on a better understa nding of the biological basis of secondary brain damage; therapeutic o r prophylactic techniques include the use of specific pharmacological agents, hypothernia, hemodilution and maintenance of an elevated cereb ral perfusion pressure. In short, although the fav ourable effects of such techniques are nor easy to demonstrate in man, their use in today 's clinical practice, in association with the concept of the chemical brain retractor, is an effective way to prevent ischemic cerebral insu lts during neurosurgical procedures.