Intravenous agents and intraoperative neuroprotection. Beyond barbiturates.

The authors discuss the role of intravenous anesthetic agents in brain protection. The newer intravenous anesthetics, etomidate and propofol, have been proposed as neuroprotective agents. Thiopental remains the drug of choice, however, for use prior to intraoperative ischemic events. The anesthetic ketamine presents surprising similarities to other N-methyl-D-aspartate receptor inhibitors, but remains controversial in its use in neurologically compromised patients.