Pharmacologic neuroprotection: the search continues

Dozens of drugs have been studied in an attempt to mitigate the adverse cerebral consequences of cardiac surgery. The targets for these drugs have focused on pathways identified through the cascade of events that occurs once cerebral ischemia is initiated. In addition, inflammatory targets specific to cardiopulmonary bypass have also been addressed. Although no drugs are yet approved as specific neuroprotective agents, trials continue of increasingly unique targets, with fewer unwanted side effects and acting through novel mechanisms of action. This review summarizes the past, present, and future of pharmacologic neuroprotection for cardiac surgery.