FKCPCPurpose: To analyze studies of neurological injury after open-heart surgery in infants and children and to discuss the effects of cardiopulmonary bypass, hypothermia and deep hypothermic circulatory arrest on cerebral blood flow, cerebral metabolism and brain temperature. Source: Articles were obtained from the databases, Current Science and Medline, from 1966 to present. Search terms include cardiopulmonary bypass(CPB), hypothermia, cerebral blood flow(CBF), cerebral metabolism and brain temperature. Information and abstracts obtained from meetings on the topic of brain and cardiac surgery helped complete the collection of information. Principal findings: In adults the incidence of neurological morbidity is between 7 to 87% with stroke in about 2-5%, whereas the incidence of neurological morbidity increases to 30% in infants and children undergoing cardiopulmonary bypass. Besides the medical condition of the patient, postoperative cerebral dysfunction and neuronal ischaemia associated with cardiac surgery in infants and small children are a combination of intraoperative factors. Deep hypothermic circulatory arrest impairs CBF and cerebral metabolism even after termination of CPB. Inadequate and/or non-homogenous cooling of the brain before circulatory arrest, as well as excessive rewarming of the brain during reperfusion are also major contributory factors. Conclusion: Newer strategies, including the use of low-flow CPB, pulsatile CPB, pH-stat acid-base management and a cold reperfusion, are being explored to ensure better cerebral protection, Advances in monitoring technology and better understanding of the relationship of cerebral blood flow and metabolism during the different modalities of cardiopulmonary bypass management will help in the medical and anaesthetic development of strategies to improve neurological and developmental outcomes.Objectif: Examiner les Etudes portant sur les atteintes neurologiques survenues apr& une chirurgie b. coeur ouvert chez les bEbEs et les enfants et discuter des effets de la circulation extracorporelle, de l'hypothermie et de l'arr~t circulatoire sous hypothermie profonde sur le debit sanguin c&~bral, sur le m&abolisme c&Ebral et sur la temperature du cerveau. Sources documentaires : Des articles ont &E choisis ~ partir de bases de donnEes, Current Science et Medline, de 1966 ~ aujourd'hui. Les mots-cl& utilis& Etaient : circulation extracorporelle (CEC), hypothermie, debit sanguin cErEbral (DSC), mEtabolisme cErEbral et temperature du cerveau. Les informations et les rEsumEs obtenus & la suite de sEminaires sur le cerveau et la chirurgie cardiaque ont permis de completer la cueillette de donn&s. I)onn&s principales : Chez les adultes, l'incidence de morbiditE neurologique avec accident vasculaire est de 7 87 % clans 2 ~. S % des cas tandis que l'incidence de morbiditE neurologique augmente & 30 % chez les bEb~s et les enfants subissant une circulation extracorporelle. La condition mEdicale du patient raise & part, le d&~glement cErEbral postop&atoire et l'ischEmie neu...

Although the quality of clinical trials in four major anesthesia journals has increased steadily during the past two decades, specific areas of trial methodology require further attention.

At clinical dosages, LA did not cause any hypocoagulable changes on the thromboelastographic profile of healthy parturients.