[Ischemic tolerance (preconditioning) of the brain].

Ischemic tolerance (preconditioning) is taken to mean a short ischemic episode subfatal to cells that activates the protective endogenous mechanisms that ensure tolerance of further longer and more severe episodes of ischemia by the organ (tissue). The present review attempts to analyze information on ischemic preconditioning in the light of the possible use for brain protection. Experimental models, temporal aspects, crossed tolerance, genomic reaction, and mechanisms are considered. There is evidence for human ischemic preconditioning.

[Brain protection during ischemia: state-of-the-art].

The paper reviews the studies dealing with cerebral ischemia and neuroprotection. On this basis, the authors make conclusions on the perspectives of development of this direction and indicate the difficulties investigators and practitioners face in solving the problems in the protection of the brain from local and global ischemic lesion. Current views of the effectiveness of drugs and procedures used in daily practice and the authors' own experience in solving this topical anesthesiological and resuscitative problem are given.

[Problems in brain protection]. / Problemy zashchity mozga.

The main aim of intensive care in acute head injury and in the postoperative period is to prevent, detect, and revert a secondary neuronal injury. To maintain the optimum systemic and cerebrovascular functions can substantially promote this aim achievement. There are some new neuroprotective interventions that are currently under investigation. Although the major focus of recent cerebral protection researches has been on the development of receptor-specific drugs, this effort has resulted in better outcomes. At present, patients are well served by using more traditional techniques to prevent and treat cerebral ischemic events. Initial therapy should include interventions to improve cerebral perfusion and the oxygen-carrying capacity of blood. Once this is accomplished, measures should be made to monitor blood glucose concentrations and to treat fever. General anesthetic choice may be of great importance in monitoring intracranial pressure and seizure activity. However, if direct cerebral protection is desired, a barbiturate should be the anesthetic of choice. All these measures should increase the chance of patients to neurologically recover following hypoxia and ischemia.