Approaches to the prevention of cerebral ischemia in the postoperative period fall into five broad categories:

1. balancing cerebral substrate supply to metabolic demand with drugs which reduce cerebral metabolic rate;

2. maintaining adequate fluid balance while preventing brain swelling;

3. maintaining normoglycemia because of the adverse effects of hyperglycemia on ischemic brain;

4. the renewed interest in moderate hypothermia;

5. the use of specific antagonists against mediators of cerebral injury.

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