Effects of Isolated Impaired Fasting Glucose on Brain Injury During Cardiac Surgery Under Cardiopulmonary Bypass

Zhou, Tao; Li, Suining; Xiang, Dingcheng; Gao, Lufang

doi:10.1080/08941939.2018.1519049

Cited by 8 publications

(9 citation statements)

References 40 publications

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“…This leads to a rise in the concentration of acidic metabolites such as lactate, which contributes to intracellular acidosis. Lactate may cross the disrupted blood brain barrier and contribute to neurocognitive impairment via excess increases in intracellular calcium concentration, mitochondrial dysfunction, and protein denaturation ( 147 , 148 ). Lastly, hyperglycaemia may disrupt the autonomic regulation of cerebral vasculature, delaying neurocognitive recovery following cardiac surgery ( 148 ).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

“…They found that there were no differences in MMSE scores between the impaired fasting glucose and control groups at 7 days ( p = 0.704). However, Neuron Specific Enolase (NSE) and S100B concentrations were significantly higher in the impaired fasting glucose group immediately following the termination of CPB, 2 h after the termination of CPB and 24 h postoperatively ( 148 ). This suggests that while overt neurocognitive deterioration and postoperative cognitive dysfunction was minimally observed in the impaired fasting glucose group, subclinical manifestations of brain injury may have been present.…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

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An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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“…This leads to a rise in the concentration of acidic metabolites such as lactate, which contributes to intracellular acidosis. Lactate may cross the disrupted blood brain barrier and contribute to neurocognitive impairment via excess increases in intracellular calcium concentration, mitochondrial dysfunction, and protein denaturation [144,145]. Lastly, hyperglycaemia may disrupt the autonomic regulation of cerebral vasculature, www.videleaf.com delaying neurocognitive recovery following cardiac surgery [145].…”

Section: Pathophysiological Mechanismmentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Vu¹,

Smith²

2022

Which Factors Contribute to Innovative Performance? A Case Study Applied to the Food and Beverage Industry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyze the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs intravenous anaesthesia, and the efficacy of dexmedetomidine.

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“…There are additional studies, which underline the role of the intraoperative cerebral desaturation, oxygen delivery and utilization, embolic load, hypo- and hyperthermia, or intraoperative glucose homeostasis [ 53 ], also potential neurotoxicity of anesthetic dosage [ 54 , 55 , 56 ], but other invariably emphasize the fact that the inflammatory response plays a key role in the pathogenesis of POD ( Figure 2 ) [ 33 , 35 , 57 ].…”

Section: Pathomechanisms Of Delirium After Cardiac Surgerymentioning

confidence: 99%

Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery—Review

Majewski¹,

Zegan-Barańska

Karolak

et al. 2020

Medicina

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Postoperative cognitive disorders after cardiac surgery may manifest as postoperative delirium (POD) or later as postoperative cognitive dysfunction (POCD). The incidence of POD after cardiac surgery ranges from 16% to 73%. In contrast to POD, POCD is usually diagnosed after the discharge from hospital, with an incidence of 30 to 70% of cases, very often noticed only by close relative or friends, decreasing after six (20–30%) and twelve (15–25%) months after surgery. Perioperative cognitive disorders are associated with adverse short- and long-term effects, including increased morbidity and mortality. Due to the complexity of delirium pathomechanisms and the difficulties in the diagnosis, researchers have not yet found a clear answer to the question of which patient will be at a higher risk of developing delirium. The risk for POD and POCD in older patients with numerous comorbidities like hypertension, diabetes, and previous ischemic stroke is relatively high, and the predisposing cognitive profile for both conditions is important. The aim of this narrative review was to identify and describe biomarkers used in the diagnosis of delirium after cardiac surgery by presenting a search through studies regarding this subject, which have been published during the last ten years. The authors discussed brain-derived biomarkers, inflammation-related biomarkers, neurotransmitter-based biomarkers, and others. Work based on inflammation-related biomarkers, which are characterized by the low cost of implementation and the effectiveness of delirium diagnosis, seems to be the closest to the goal of discovering an inexpensive and effective marker. Currently, the use of a panel of tests, and not a single biomarker, brings us closer to the discovery of a test, or rather a set of tests ideal for the diagnosis of delirium after cardiac surgery.

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Effects of Isolated Impaired Fasting Glucose on Brain Injury During Cardiac Surgery Under Cardiopulmonary Bypass

Cited by 8 publications

References 40 publications

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery—Review

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