Hypertension as a risk factor for cerebral injury during cardiopulmonary bypass

Schmidt, M; Scheunert, T; Steinbach, Gerald; Schirmer, Uwe; Marx, Thomas; Freitag, Nils; Reinelt, Helmut

doi:10.1046/j.1365-2044.2001.02105.x

Cited by 21 publications

(16 citation statements)

References 24 publications

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“…40 A small cohort study of 22 patients then suggested that preoperative chronic hypertension is associated with higher levels of S100B in cardiac surgery patients. 41 The authors speculated that the poor cerebral blood flow autoregulation secondary to chronic hypertension might predispose BBB dysfunction during CPB and thus initiate the release of S100B. 41 There was a positive correlation between postoperative serum levels of S100B and age in 56 patients who underwent coronary artery bypass graft (CABG) surgery.…”

Section: S100b In Cardiac Surgerymentioning

confidence: 99%

Neurological biomarkers in the perioperative period

Cata

Abdelmalak

Farag

2011

British Journal of Anaesthesia

101

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The rapid detection and evaluation of patients presenting with perioperative neurological dysfunction is of great clinical relevance. Biomarkers have been defined as biological molecules that can be used as an indicator of new onset or progression of a biological process or effect of treatment. Biomarkers have become increasingly important in this setting to supplement other modalities of diagnosis such as EEG, sensory- or motor-evoked potential, transcranial Doppler, near-infrared spectroscopy, or imaging methods. A number of neuro-proteins have been identified and are currently under investigation for potential to provide insights into injury severity, outcome, and the ability to monitor cellular damage and molecular events that occur during neurological injury. S100B is a protein released by glial cells and is considered a marker of blood-brain barrier dysfunction. Clinical studies in patients undergoing cardiac and non-cardiac surgery indicate that serum levels of S100B are increased intraoperatively and after operation. The neurone-specific enolase has also been extensively investigated as a potential marker of neuronal injury in the context of cardiac and non-cardiac surgery. A third biomarker of interest is the Tau protein, which has been linked to neurodegenerative disorders. Tau appears to be more specific than the previous two biomarkers since it is only found in the central nervous system. The metalloproteinase and ubiquitin C terminal hydroxylase-L1 (UCH-L1) are the most recently researched markers; however, their usefulness is still unclear. This review presents a comprehensive overview of S100B, neuronal-specific enolase, metalloproteinases, and UCH-L1 in the perioperative period.

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Section: S100b In Cardiac Surgerymentioning

confidence: 99%

Neurological biomarkers in the perioperative period

Cata

Abdelmalak

Farag

2011

British Journal of Anaesthesia

101

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“…However, in these studies the investigators did not separately analyze patients with hypertension who, as a result of altered cerebrovascular autoregulation, might be at greater risk for decreased cerebral perfusion secondary to decreased systemic blood pressure 7. This view is supported by a study of patients undergoing cardiac surgery, which demonstrated that hypertensive patients had higher postoperative increases in peripheral blood levels of S100B, a marker of cerebral injury 8. They hypothesized that this larger increase was the result of altered cerebrovascular autoregulation, and suggested that cardiopulmonary bypass management protocols may need adjustment to improve cerebral perfusion in hypertensive patients.…”

mentioning

confidence: 99%

Neurocognitive Performance in Hypertensive Patients after Spine Surgery

Yocum¹,

Gaudet²,

Teverbaugh³

et al. 2009

Anesthesiology

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Background Cognitive dysfunction is fairly common after noncardiac surgery and may be related to intraoperative blood pressure management. The authors present an analysis of risk factors for cognitive deterioration after spine surgery in older patients, with particular emphasis on intraoperative blood pressure in normotensive and hypertensive patients. Methods This is a post hoc cohort analysis of 45 patients enrolled before undergoing lumbar laminectomy or microdiscectomy. The patients underwent a battery of 5 neuropsychometric tests preoperatively, and 1 day and 1 month postoperatively. Computerized anesthesia records were used to obtain intraoperative mean arterial pressure (MAP) data. Simple linear regressions between intraoperative MAP and postoperative cognitive performance were performed, and multivariate linear regression models of postoperative cognitive performance were constructed to analyze potential risk factors for cognitive decline after surgery. Results Twenty-one normotensive patients (mean age, 62.4 yr) and 24 hypertensive patients (mean age, 67.9 yr) were included in this analysis. There was a significant positive relationship between minimum intraoperative MAP values and 1-day cognitive performance by simple linear regression in hypertensive (P = 0.003), but not normotensive, patients. In multivariate linear regression analysis of cognitive performance, there was a significant interaction between hypertension and minimum intraoperative MAP at 1 day and 1 month. Conclusions In hypertensive patients, there was a significant relationship between minimum intraoperative MAP and decline in cognitive function 1 day and 1 month after surgery. A prospective controlled trial of intraoperative blood pressure control, especially during induction of anesthesia when MAP values typically drop, is needed to confirm these findings.

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“…Our findings suggest that BIS sensors should be placed on the non‐diseased side of the forehead in patients with unilateral carotid artery or cerebrovascular disease. In addition, hypertensive patients with carotid artery disease may be more susceptible to low arterial blood pressure due to the shifting upwards of the cerebral autoregulation curve 7,8 and impaired cerebral autoregulation distal to carotid stenosis 9 . Therefore, during operation in these patients, blood pressure increase may be needed to increase cerebral blood flow and subsequent oxygen supply in brain regions with impaired autoregulation.…”

Section: Discussionmentioning

confidence: 99%

Different bispectral index values from both sides of the forehead in unilateral carotid artery stenosis

Lee

Choi

Song

et al. 2008

Acta Anaesthesiol Scand

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Bispectral index (BIS) values derived from the left and right forehead are usually the same. We report on two patients with unilateral carotid artery stenosis in whom we observed differences between the BIS values obtained from sensors placed on each side of the forehead. During surgery, the BIS values of the diseased side decreased more than those of the opposite side when the mean arterial pressure decreased below 70 mmHg. BIS monitors should be used with caution in patients with unilateral carotid artery and cerebrovascular disease.

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Hypertension as a risk factor for cerebral injury during cardiopulmonary bypass

Cited by 21 publications

References 24 publications

Neurological biomarkers in the perioperative period

Neurological biomarkers in the perioperative period

Neurocognitive Performance in Hypertensive Patients after Spine Surgery

Different bispectral index values from both sides of the forehead in unilateral carotid artery stenosis

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