Cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass are related to postoperative cognitive deterioration: prospective observational study

Kumpaitiene, Birute; Švagždienė, Milda; Širvinskas, Edmundas; Adomaitienė, Virginija; Petkus, Vytautas; Žakelis, Rolandas; Krakauskaite, Solventa; Chomskis, Romanas; Ragauskas, Arminas; Benetis, Rimantas

doi:10.23736/s0375-9393.18.12358-3

Cited by 25 publications

(29 citation statements)

References 32 publications

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“…Additionally, several intraoperative issues related to POCD occurrence have been described in the literature. Mean arterial pressure has been shown to need to be maintained between 80 and 90 mmHg during CPB, without intraoperative pressure dropping more than 32 mmHg [51], because brain hypoperfusion may lead to POCD [52]. Similarly, surgical manipulation during beating-heart surgery may reduce cardiac output; therefore, decreasing systemic blood pressure might reduce the brain perfusion index [12,53].…”

Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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The growing number of publications concerning postoperative cognitive decline (POCD) after cardiac surgery is indicative of the health-related and economic-related importance of this intriguing issue. Significantly, the reported POCD incidence over the years has remained steady due to various unresolved challenges regarding the examination of this multidisciplinary topic. In particular, a universally accepted POCD definition has not been established, and the pathogenesis is still vaguely understood. However, numerous recent studies have focused on the role of the inflammatory response to a surgical procedure in POCD occurrence. Therefore, this traditional narrative review summarizes and evaluates the latest findings, with special attention paid to the difficulties of defining POCD as well as the involvement of inflammation in POCD development. We searched the MEDLINE, Scopus, PsycINFO and CENTRAL databases for the best evidence, which was classified according to the Oxford Centre for Evidence-based Medicine. To our knowledge, this is the first narrative review that identified class-1 evidence (systematic review of randomized trials), although most evidence is still at class-2 or below. Furthermore, we revealed that defining POCD is a very controversial matter and that the inflammatory response plays an important role in the mutually overlapping processes included in POCD development. Thus, developing the definition of POCD represents an absolute priority in POCD investigations, and the inflammatory response to cardiac surgery merits further research.

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Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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“…Vasoconstriction of arterioles and capillary vessels was the physiological autoregulatory reaction to increased mean arterial blood pressure (MAP). The blood volume inside the acoustic path decreased in cases, while that monitored by the speed of ultrasound also decreased [30,39]. The capability to sense overall integrated volumetric reactions of the brain and increased temporal resolution of CA monitoring were the primary advantages of this ultrasonic method compared with other methods based on local blood volume/velocity measurements by using near-infrared spectroscopy (NIRS) and Doppler technology applications [40][41][42][43][44][45].…”

Section: Cerebral Autoregulation Assessmentmentioning

confidence: 99%

Comparative Study of Novel Noninvasive Cerebral Autoregulation Volumetric Reactivity Indices Reflected by Ultrasonic Speed and Attenuation as Dynamic Measurements in the Human Brain

et al. 2020

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This is a comparative study of two novel noninvasive cerebrovascular autoregulation (CA) monitoring methods based on intracranial blood volume (IBV) changes in the human brain. We investigated the clinical applicability of the new volumetric reactivity index (VRx2), reflected by intracranial ultrasonic attenuation dynamics for noninvasive CA monitoring. The CA was determined noninvasively on 43 healthy participants by calculating the volumetric reactivity index (VRx1 from time-of-flight of ultrasound, VRx2 from attenuation of ultrasound). The VRx was calculated as a moving correlation coefficient between the arterial blood pressure and noninvasively measured IBV slow waves. Linear regression between VRx1 and VRx2 (averaged per participants) showed a significant correlation (r = 0.731, p < 0.0001, 95% confidence interval [0.501–0.895]) in data filtered by bandpass filtering. On the other hand, FIR filtering demonstrated a slightly better correlation (r = 0.769, p < 0.0001, 95% confidence interval [0.611–0.909]). The standard deviation of the difference by bandpass filtering was 0.1647 and bias −0.3444; and by FIR filtering 0.1382 and bias −0.3669. This comparative study showed a significant coincidence of the VRx2 index compared to that of VRx1. Hence, VRx2 could be used as an alternative, cost-effective noninvasive cerebrovascular autoregulation index in the same way as VRx1 values are used.

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“…109,110 in an observational study on 59 patients who underwent cardiopulmonary bypass for elective coronary surgery, Kumpaitiene et al showed that impairment of the cerebrovascular autoregulation was associated with a higher incidence of postoperative cognitive disorders. 111 a consensus paper on anesthesia in urogynecologic robotic surgery was produced by a joined task force of siaarti, sigo, and siU and published in august. 112 Following a systematic review of the literature, the authors identified nine core contents; recommendations concerned patient position, neuromuscular block, pneumoperitoneum and ventilation strategies, hemodynamic monitoring, fluid therapy, pain management, and prevention of nausea and vomiting, acute kidney injury, postoperative delirium, and cognitive dysfunction.…”

Section: Regional Anesthesiamentioning

confidence: 99%

A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine

Cavaliere¹,

Allegri²,

Apan³

et al. 2021

Minerva Anestesiol

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Cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass are related to postoperative cognitive deterioration: prospective observational study

Cited by 25 publications

References 32 publications

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Comparative Study of Novel Noninvasive Cerebral Autoregulation Volumetric Reactivity Indices Reflected by Ultrasonic Speed and Attenuation as Dynamic Measurements in the Human Brain

A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine

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