Neurobehavioral outcomes in cardiac operations

Bd, Townes; Bashein, G.; Tf, Hornbein; Db, Coppel; De, Goldstein; Kb, Davis; Ml, Nessly; Sw, Bledsoe; Rc, Veith; Td, Ivey

doi:10.1016/s0022-5223(19)34300-4

Cited by 136 publications

(37 citation statements)

References 18 publications

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“…In addition some patients refuse or give up on individual tests in the test battery. Missing test scores can be handled in several ways: it may be given the worst score observed (50, 59), the average score (40) or, preferably, excluded from the analysis. Inability to comprehend the instruction or complete the test could make the use of the worst score reasonable while unwillingness to participate should probably lead to the use of the average value.…”

Section: Neuropsychological Testing Of Surgical Patientsmentioning

confidence: 99%

The assessment of postoperative cognitive function

Rasmussen

Strandberg‐Larsen

Houx

et al. 2001

Acta Anaesthesiol Scand

492

403

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Postoperative cognitive function (POCD) has been subject to extensive research. In the literature, large differences are apparent in methodology such as the test batteries, the interval between sessions, the endpoints to be analysed, statistical methods, and how neuropsychological deficits are defined. Traditionally, intelligence tests or tests developed for clinical neuropsychology have been used. The tests for detecting POCD should be based on well-described sensitivity and suitability in relation to surgical patients. In tests using scores, floor/ceiling effects may compromise the evaluation if the tests are either too easy or to difficult. Uncontrolled testing facilities and change of test personnel may affect the test performance. Practice effects are pronounced in neuropsychological tests but have generally been ignored. The use of a suitable normative population is essential to allow correction for practice effects and variability between sessions. Missing follow-up may severely compromise valid conclusions since subjects unable or unwilling to be examined are particularly prone to suffer from POCD. In the statistical analysis of the test results, the evaluation should be based on differences between pre- and postoperative performance. Parametric statistical tests are not relevant unless the appropriate Gaussian distributions are present, perhaps after transformation of data. The definition of cognitive dysfunction should be restrictive and the criteria should be fulfilled in only a small proportion of volunteers. In the literature, these requirements often have not been fulfilled. This precludes a reasonable estimation of the incidence of POCD and the conclusions of comparative studies should be interpreted with great caution. In this review article, we present a number of recommendations for the design and execution of studies within this area. In addition, the critical reader may use these recommendations in the evaluation of the literature.

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Section: Neuropsychological Testing Of Surgical Patientsmentioning

confidence: 99%

The assessment of postoperative cognitive function

Rasmussen

Strandberg‐Larsen

Houx

et al. 2001

Acta Anaesthesiol Scand

492

403

View full text Add to dashboard Cite

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“…No gross perfusion abnormalities were de tected by visual analysis; however, when quantified SPECT images showed an increase in the total MCA ROI counts: The respective preoperative-intraoperative ratios were 0.89 and 0.86 for the right and left MCAs in Patient 1 and 0.83 and 0.85 in Patient 2. Thus, " mTc-HMPAO uptake increased by 11 to 14% in Patient 1 and 15 to 17% in Patient 2, com pared to baseline values (see Figs 1,2).…”

Section: R E Su Ltsmentioning

confidence: 60%

Feasibility of SPECT for Studies of Brain Perfusion During Cardiopulmonary Bypass

Marochnik

Alexandrov²,

Anthone³

et al. 1996

Journal of Neuroimaging

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Single-photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasonography were used to assess brain perfusion during cardiopulmonary bypass. Intravenous injections of technetium 99 m-hexamethylpropyleneamineoxime (99mTc-HMPAO) were administered before surgery and intraoperatively after the first 2 minutes in the first patient and at the end (42 minutes) of cardiopulmonary bypass in the second patient. The total middle cerebral artery territory counts were calculated using the region-of-interest method and compared to cerebellar regional counts. 99mTc-HMPAO uptake on SPECT scans was increased at the beginning and at the end of cardiopulmonary bypass, compared to baseline preoperative values (11-17%) in the presence of multiple microembolic signals on TCD (n1 = 35 and n2 = 42 for unilateral middle cerebral artery monitoring). These results indicate the feasibility of using HMPAO-SPECT to study brain perfusion changes during cardiac surgery. A combination of SPECT and TCD ultrasonography may be used to study the impact of microembolism during cardiac surgery with cardiopulmonary bypass.

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“…several reports have demonstrated ongoing cognitive impairment in a small percentage of cases. [5][6][7][12][13][14][15] By contrast, much less is known about cognitive function in patients before or after PTCA.…”

mentioning

confidence: 99%