Cerebral resuscitation: advances and controversies

Brain protection is the prevention or amelioration of neuronal damage occurring after a hypoxic or ischemic event. Controversies in this field focus on whether incomplete global ischemia may produce a worse insult than does complete global ischemia; whether barbiturates provide protection following complete global ischemia; and whether the calcium entry blockers have a role in brain protection. Current knowledge dictates that incomplete ischemia coupled with hyperglycemia will cause a severe cerebral lactic acidosis and produce a worse insult than does complete ischemia. In the absence of hyperglycemia complete cerebral ischemia produces more neuronal damage. The barbiturates have been shown to provide protection in focal ischemia and incomplete global ischemia in which neuronal function is still present, but have not been shown to provide protection following complete global ischemia. Those calcium entry blockers with cerebral vascular selectivity may well provide some brain protection following complete cerebral ischemia by ameliorating the postischemic hypoperfusion state.