Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery (original) (raw)
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Brazilian Journal of Anesthesiology (English Edition), 2018
Background and objectives: Postoperative cognitive dysfunction is common after cardiac surgery. Adequate cerebral perfusion is essential and near infrared spectroscopy (NIRS) can measure cerebral oxygenation. Aim of this study is to compare incidence of early and late postoperative cognitive dysfunction in elderly patients treated with conventional or near infrared spectroscopy monitoring. Methods: Patients undergoing coronary surgery above 60 years, were included and randomized to 2 groups; control and NIRS groups. Peroperative management was NIRS guided in GN; and with conventional approach in control group. Test battery was performed before surgery, at first week and 3rd month postoperatively. The battery comprised clock drawing, memory, word list generation, digit spam and visuospatial skills subtests. Postoperative cognitive dysfunction was defined as drop of 1 SD (standard deviation) from baseline on two or more tests. Mann-Whitney U test was used for comparison of quantitative measurements; Chi-square exact test to compare quantitative data. Results: Twenty-one patients in control group and 19 in NIRS group completed study. Demographic and operative data were similar. At first week postoperative cognitive dysfunction were present in 9 (45%) and 7 (41%) of patients in control group and NIRS group respectively. At third month 10 patients (50%) were assessed as postoperative cognitive dysfunction; incidence was 4 (24%) in NIRS group (p:0.055). Early and late postoperative cognitive dysfunction group had significantly longer ICU stay (1.74 + 0.56 vs. 2.94 + 0.95; p < 0.001; 1.91 + 0.7 vs. 2.79 + 1.05; p < 0.01) and longer hospital stay (9.19 + 2.8 vs. 11.88 + 1.7; p < 0.01; 9.48 + 2.6 vs. 11.36 + 2.4; p < 0.05).
Perioperative Hyperoxia and Delirium after On-pump Cardiac Surgery: A Mediation Analysis
BackgroundNeurologic and neurobehavioural complications are common after cardiac surgery with cardiopulmonary bypass (CPB). Exposure to the artificial bypass surface, conversion to laminar flow and hypothermia likely contribute to systemic inflammation observed after CPB. To ensure adequate systemic oxygenation, the CPB patient is often exposed to supraphysiologic levels of oxygen. Relative to normoxia, perioperative hyperoxia during CPB has not been shown to impact neurocognition in the long-term. Whether this holds true for the immediate post-operative neurocognitive function is the question of this nested case-control study.Methods46 age-and sex-matched subjects, aged ≥65 years, selected for this study were randomized to receive normoxia or hyperoxia during CABG with CPB in the parent trial. Levels of four neuroinflammatory biomarkers (S100B, ENO2, CHI3L1, UCHL1) were measured at baseline and at post-bypass. Baseline neurocognition was established with the Montreal Cognitive Asse...
Journal of Cardiothoracic and Vascular Anesthesia, 2004
To evaluate the relationship between cerebral oxygen saturation and neuropsychological dysfunction after cardiac surgery. Design: Prospective and observational study. Setting: Operating room and cardiac floor of a university hospital. Participants: One hundred one patients undergoing elective cardiac surgery with cardiopulmonary bypass Intervention: Bilateral noninvasive cerebral oxygen saturations were monitored over the forehead. The anesthetic and surgical techniques were performed as usual, and no interventions were attempted based on the monitor. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE) and the antisaccadic eye movement test (ASEM). Measurements and Main Results: Preoperative baseline values of cerebral oxygen saturation (rSO 2) were 58.6% ؎ 10.2%. Patients with the nadir rSO 2 <35% had significantly higher incidences of postoperative ASEM and MMSE impairments than those with rSO 2 always above 35% (44% and 33% v 12% and 9%, respectively). Patients with areas of rSO 2 <40% for more than 10 minutes • % presented with a significantly higher incidence of postoperative ASEM and MMSE impairments than those with areas of rSO 2 <40% for less than 10 minutes • % (42% and 32% v 13% and 10%, respectively). Patients with postoperative ASEM or MMSE impairment had significantly lower nadir rSO 2 and significantly larger areas of rSO 2 <40%, <45%, and <50% than those with normal postoperative neuropsychological outcome. However, multivariate logistic regression analysis showed that areas of rSO 2 <40% were the only predictor for both postoperative ASEM and MMSE impairments. Conclusions: Intraoperative cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery with cardiopulmonary bypass. However, it remains to be determined whether interventions to maintain adequate cerebral oxygenation may improve neuropsychological outcome.
Annals of Thoracic Surgery, 2009
Background. Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSO 2 ) saturation. The purpose of this study is to examine whether decreased rSO 2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG).
Intraoperative cerebral oxygenation, oxidative injury, and delirium following cardiac surgery
Free radical biology & medicine, 2016
Delirium affects 20-30% of patients after cardiac surgery and is associated with increased mortality and persistent cognitive decline. Hyperoxic reperfusion of ischemic tissues increases oxidative injury, but oxygen administration remains high during cardiac surgery. We tested the hypothesis that intraoperative hyperoxic cerebral reperfusion is associated with increased postoperative delirium and that oxidative injury mediates this association. We prospectively measured cerebral oxygenation with bilateral oximetry monitors in 310 cardiac surgery patients, quantified intraoperative hyperoxic cerebral reperfusion by measuring the magnitude of cerebral oxygenation above baseline after any ischemic event, and assessed patients for delirium twice daily in the ICU following surgery using the confusion assessment method for ICU (CAM-ICU). We examined the association between hyperoxic cerebral reperfusion and postoperative delirium, adjusted for the extent of cerebral hypoxia, the extent of...
Anaesthesia, 2014
Coronary artery bypass surgery, performed with or without cardiopulmonary bypass, is frequently followed by postoperative cognitive decline. Near-infrared spectroscopy is commonly used to assess cerebral tissue oxygenation, especially during cardiac surgery. Recent studies have suggested an association between cerebral desaturation and postoperative cognitive dysfunction. We therefore studied cerebral oxygen desaturation, defined as area under the cerebral oxygenation curve < 40% of > 10 min.%, with respect to cognitive performance at 4 days (early) and 3 months (late) postoperatively, compared with baseline, using a computerised cognitive test battery. We included 60 patients, of mean (SD) age 62.8 (9.4) years, scheduled for elective coronary artery bypass grafting, who were randomly allocated to surgery with or without cardiopulmonary bypass. Cerebral desaturation occurred in only three patients and there was no difference in cerebral oxygenation between the two groups at an...
Trials, 2017
Anesthesiologists administer excess supplemental oxygen (hyper-oxygenation) to patients during surgery to avoid hypoxia. Hyper-oxygenation, however, may increase the generation of reactive oxygen species and cause oxidative damage. In cardiac surgery, increased oxidative damage has been associated with postoperative kidney and brain injury. We hypothesize that maintenance of normoxia during cardiac surgery (physiologic oxygenation) decreases kidney injury and oxidative damage compared to hyper-oxygenation. The Risk of Oxygen during Cardiac Surgery (ROCS) trial will randomly assign 200 cardiac surgery patients to receive physiologic oxygenation, defined as the lowest fraction of inspired oxygen (FIO2) necessary to maintain an arterial hemoglobin saturation of 95 to 97%, or hyper-oxygenation (FIO2 = 1.0) during surgery. The primary clinical endpoint is serum creatinine change from baseline to postoperative day 2, and the primary mechanism endpoint is change in plasma concentrations of...
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.
Effects of Extreme Hemodilution during Cardiac Surgery on Cognitive Function in the Elderly
Anesthesiology, 2007
Background Strategies for neuroprotection including hypothermia and hemodilution have been routinely practiced since the inception of cardiopulmonary bypass. Yet postoperative neurocognitive deficits that diminish the quality of life of cardiac surgery patients are frequent. Because there is uncertainty regarding the impact of hemodilution on perioperative organ function, the authors hypothesized that extreme hemodilution during cardiac surgery would increase the frequency and severity of postoperative neurocognitive deficits. Methods Patients undergoing coronary artery bypass grafting surgery were randomly assigned to either moderate hemodilution (hematocrit on cardiopulmonary bypass >or=27%) or profound hemodilution (hematocrit on cardiopulmonary bypass of 15-18%). Cognitive function was measured preoperatively and 6 weeks postoperatively. The effect of hemodilution on postoperative cognition was tested using multivariable modeling accounting for age, years of education, and ba...