Prognostic Value of Electroencephalography in Cardiac Surgery (original) (raw)
Related papers
Objective: To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Methodology: Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off-pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. Results: There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSO 2 in different hours of surgery was significant in group I and group II (P=0.0001 in both ) but it was not significant in group III ( P=0.075) . Conclusion: Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications.
Pakistan Journal of Medical Sciences Online
Objective: To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Methodology: Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off- pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. Results: There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSO2 in different hours of surgery was significant in group I and group II (P=0.0001 in both ) but it was not significant in group III ( P=0.075) . Conclusion: Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications.
British Journal of Anaesthesia, 1999
We studied 15 patients undergoing cardiac surgery involving hypothermic cardiopulmonary bypass (CPB). Cerebral arteriovenous difference in oxygen content (AVDO2) was significantly less during CPB and for up to 18 h after operation compared with pre-CPB values (P<0.05). There were no significant changes in mean jugular bulb oxyhaemoglobin saturation (Sjvo 2 ), cerebral arteriovenous difference in lactate content or lactate-oxygen index (LOI). SJVQ 2 and arterial carbon dioxide tension (Paco 2 ) (P=0.005) were positively correlated as were AVDO2 and haemoglobin concentration (P=O.OI2). AVDO2 and Paco 2 (P-0.007) were negatively correlated as were LOI and arterial oxyhaemoglobin saturation (P=0.037). There were no significant correlations between mean arterial pressure and any of the variables. SJVQ 2 and AVDO2 may require correction for changes in Paco 2 ar| d haemoglobin concentration before relating these variables to cerebral outcome.
Pathophysiology of the cerebral circulation during cardiac surgery
Critical Care, 2000
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1].
Recognition and prevention of neurological complications in paediatric cardiac surgery
Critical Care, 2000
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1]. Critical Care Vol 4 Suppl B Abstracts of the 2 nd International Symposium on the Pathophysiology of Cardiopulmonary Bypass References 1. Young WL, Ornstein E: Cerebral and spinal cord blood flow. In: Anesthesia and Neurosurgery. Edited by Cottrell JE, Smith DS. St. Louis, MO: Mosby, 1994:17-58. 2. Murkin JM, Farrar JK, Tweed WA, et al: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO 2 . Anesth Analg 1987, 66:825-832. 3. Hindman BJ, Funatsu N, Harrington J, et al: Cerebral blood flow response to PaCO 2 during hypothermic cardiopulmonary bypass in rabbits. Anesthesiology 1991, 75:662-668. 4. Paulson OB, Strandgaard S, Edvinsson L: Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990, 2:161-192. 5. Hindman BJ, Dexter F, Ryu KH, et al: Pulsatile versus nonpulsatile cardiopulmonary bypass. No difference in brain blood flow or metabolism at 27 degrees C. Anesthesiology 1994, 80:1137-1147. 6. Rogers AT, Prough DS, Roy RC, et al: Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 1992, 103:363-368. 7. Todd MM, Weeks JB, Warner DS: Cerebral blood flow, blood volume, and brain tissue hematocrit during isovolemic hemodilution with hetastarch in rats.
Brain damage in cardiac surgery patients
Current Opinion in Pharmacology, 2012
Neuropsychological disorders and brain injury are still a serious problem in cardiac surgery patients. Owing to multifactorial mechanism of brain injury during extracorporeal circulation, the effective and safe protection is extremely difficult. Despite several studies, the ideal neuroprotective treatment has not been found. Based on literature we analysed the main mechanisms of brain injury and new methods of brain protection.
Cerebral oxygenation during cardiopulmonary bypass
Archives of Disease in Childhood, 1998
Cerebral fractional oxygen extraction (FOE) was monitored in 30 children, using near infrared spectroscopy during cardiopulmonary bypass, to investigate the eVect of hypothermia and circulatory arrest. One group of children (n = 15) underwent profound hypothermia with total circulatory arrest (n = 8) or continuous flow (n = 7). Another group (n = 15), of whom only one had circulatory arrest, underwent mild (n = 6) or moderate (n = 9) hypothermia.
Neuropsychologic dysfunction after CABG: standard cardiopulmonary bypass versus off-pump CABG
Critical Care, 2000
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1]. Critical Care Vol 4 Suppl B Abstracts of the 2 nd International Symposium on the Pathophysiology of Cardiopulmonary Bypass References 1. Young WL, Ornstein E: Cerebral and spinal cord blood flow. In: Anesthesia and Neurosurgery. Edited by Cottrell JE, Smith DS. St. Louis, MO: Mosby, 1994:17-58. 2. Murkin JM, Farrar JK, Tweed WA, et al: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO 2 . Anesth Analg 1987, 66:825-832. 3. Hindman BJ, Funatsu N, Harrington J, et al: Cerebral blood flow response to PaCO 2 during hypothermic cardiopulmonary bypass in rabbits. Anesthesiology 1991, 75:662-668. 4. Paulson OB, Strandgaard S, Edvinsson L: Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990, 2:161-192. 5. Hindman BJ, Dexter F, Ryu KH, et al: Pulsatile versus nonpulsatile cardiopulmonary bypass. No difference in brain blood flow or metabolism at 27 degrees C. Anesthesiology 1994, 80:1137-1147. 6. Rogers AT, Prough DS, Roy RC, et al: Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 1992, 103:363-368. 7. Todd MM, Weeks JB, Warner DS: Cerebral blood flow, blood volume, and brain tissue hematocrit during isovolemic hemodilution with hetastarch in rats.