Differential Age Effects of Mean Arterial Pressure and Rewarming on Cognitive Dysfunction After Cardiac Surgery

Newman, MF; Kramer, David C.; Croughwell, Narda D.; Sanderson, Iain; Ja, Blumenthal; White, WD; Smith, L. R.; TOWNER, E. A.; Reves, J. G.

doi:10.1097/00132586-199610000-00033

Cited by 9 publications

(14 citation statements)

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“…The proposed causes are legion, 18 32 39 68 84 and include preoperative cerebral dysfunction, limited autoregulatory capacity, hypothermia, intraoperative hypotension, loss of pulsatile flow, macro-or micro-embolization of air, or particulate matter or cellular aggregates which may compromise cerebral perfusion. Combinations of these causes may also be harmful; Newman and colleagues 61 reported that the combination of hypotension (mean arterial LA grp showed no significant change GA grp significantly more failures than LA grp postop. pressure :50 mm Hg) and rapid rewarming contributed to cognitive deficit in elderly patients.…”

Section: Specific Anaesthetic/operative Techniques Causing Pocd Pocd mentioning

confidence: 99%

Postoperative cognitive deficit in the elderly surgical patient

Dodds¹,

Allison²

1998

British Journal of Anaesthesia

130

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Postoperative confusion is frequent in elderly patients, particularly after major emergency surgery. Berggren and colleagues 6 described confusion in 44% of elderly patients after surgical fixation of a fractured neck of femur. Changes in anxiety levels, personality and memory impairment may also occur and contribute to morbidity. 7 Longer-term effects may be possible, such as changes in personality, social integration and cognitive powers and skills, which can be described collectively as postoperative cognitive dysfunction (POCD). Over the past 40 yr many studies have been performed to assess the relationship of these features to anaesthesia and surgery. The incidence reported has varied. Despite radical changes in anaesthetic practice with the development of new drugs and monitoring techniques which should have improved safety, the proportion of patients affected remains similar to earliest reports. 12 Although the incidence appears unchanged, the number of elderly patients has been increasing, and changing expectations, in addition to advanced and more available surgical techniques means that a larger number of elderly patients undergo surgery. Survival of elderly patients after surgery has been documented in a study of the 5-yr survival of 900 postoperative patients. 26 After an initial high mortality, related to the surgical diagnosis and the urgency of surgery, mortality later approached that of an agematched population, suggesting that age alone should not be a reason not to operate. If long-term survival is not related to surgery, proportionately more procedures will be performed in older subjects, and increasing expectations of the elderly could extend the "demand" into higher age groups. This possible growth in surgical demand makes it important to establish the features, incidence and causes of POCD. History In 1955, Bedford 3 reported dementia in old people after operations under general anaesthesia. He concluded that minor degrees of dementia were common and described 18 extreme examples. No controls were available and the anaesthetic records were incomplete. From the notes that were available, several of the patients experienced severe and pro-(Br.

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Section: Specific Anaesthetic/operative Techniques Causing Pocd Pocd mentioning

confidence: 99%

Postoperative cognitive deficit in the elderly surgical patient

Dodds¹,

Allison²

1998

British Journal of Anaesthesia

130

View full text Add to dashboard Cite

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“…It is undisputed that some proportion of patients develop at least temporary cognitive complications after CABG surgery using cardiopulmonary bypass pump (CPB). Studies examining these patients at the time of their discharge have found postoperative declines in verbal and visual learning and memory, complex attention, information processing speed, and psychomotor speed in up to 70% of patients (Blumenthal et al, 1991;Croughwell et al, 1994;Newman et al, 1994Newman et al, , 1995b. When CPB patients are assessed 1 week after surgery, deficits in these same domains are found (Chabot et al, 1997;Engelhardt et al, 1996;Mora et al, 1996;Plourde et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

Presurgical cognitive deficits in patients receiving coronary artery bypass graft surgery

Rankin

Kochamba

Boone

et al. 2003

J Int Neuropsychol Soc

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Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) can produce a higher incidence of neuropsychological complications than other types of highly invasive noncardiac vascular surgery. Cognitive complications most likely arise from either embolization or hypoxia. An alternative surgical procedure has been developed that allows CABG to be performed without stopping the heart ("off-pump" CABG, or OPCABG). This study examined the neuropsychological performance of patients undergoing OPCABG, hypothesizing that patients undergoing OPCABG would show fewer cognitive deficits than patients whose hearts were stopped. A 1-hr neuropsychological battery was administered preoperatively to 43 patients before prospective randomization to either CPB CABG or OPCABG, and again to 34 of those patients 2 to 3 months postoperatively by an examiner blind to surgical condition. Neuropsychological status did not change 2.5 months postsurgically in either OPCABG or CABG groups. However, both groups showed dramatic presurgical cognitive deficits in multiple domains, particularly verbal memory and psychomotor speed. This corroborates previous research suggesting that patients requiring CABG surgery may evidence significant presurgical cognitive deficits as a result of existing vascular disease.

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“…Many authors state that of all the factors thought to be predictive for neurological and neuropsychological injury in cardiac surgery age is probably the most robust [11,12]. Although the elderly retain the capacity of cerebral autoregulation, they are at increased risk of stroke, particularly in the presence of severe aortic atherosclerosis and occult cerebrovascular disease [13].…”

Section: Discussionmentioning

confidence: 99%

Neurological Complications After Cardiac Surgery: Risk Factors and Correlation to the Surgical Procedure

Boeken

Litmathe²,

Feindt³

et al. 2005

Thorac cardiovasc Surg

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Our results show that type of surgery, symptomatic cerebrovascular disease, advanced age, diabetes mellitus, and probably aortic atheroma represent the most important risk factors for neurological complications. After preoperative consideration of the individual risk of each patient, neuroprotective interventions (arterial line filtration, alpha-stat management) and pharmacological neuroprotection may offer an improved outcome to some of these "high-risk" patients.

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Differential Age Effects of Mean Arterial Pressure and Rewarming on Cognitive Dysfunction After Cardiac Surgery

Cited by 9 publications

References 0 publications

Postoperative cognitive deficit in the elderly surgical patient

Postoperative cognitive deficit in the elderly surgical patient

Presurgical cognitive deficits in patients receiving coronary artery bypass graft surgery

Neurological Complications After Cardiac Surgery: Risk Factors and Correlation to the Surgical Procedure

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