The role of CPB management in neurobehavioral outcomes after cardiac surgery

Recent developments in techniques for managing cardiopulmonary bypass are outlined with a view toward interventions aimed at decreasing the incidence of perioperative central nervous system dysfunction and overt stroke. Recent reports assessing central nervous system dysfunction after hypothermic and normothermic cardiopulmonary bypass are reviewed and critiqued along with data assessing techniques for cerebral protection during hypothermic circulatory arrest. Controversy surrounding optimal pH management is explored along with a proposal that pH-stat may be most satisfactory to ensure better brain cooling where circulatory arrest is anticipated, whereas alpha-stat may avoid cerebral hyperemia and thus decrease the cerebral embolic load during moderate hypothermic cardiopulmonary bypass. Newer developments in cerebral monitoring techniques are also reviewed.