Psychiatric Complications of Cardiac Surgery Postoperative Delirium Syndrome

Abstract

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

“…Thus, the lack of acetylcholine or relative excess of dopaminergic transmission seems to be connected to the development of POD. The age-dependent decrease of acetylcholine transmission is a physiologic process, and reduced "cholinergic reserve" may be responsible for the significantly higher incidence of POD among geriatric patients 8,11,16) . These findings normally do not appear on conventional radiographic images as organic brain lesions, since only sophisticated targeted images can display such tiny chemical abnormalities.…”

“…Postoperative delirium (POD), one of the most unexpected and perplexing complications encountered in the perioperative period, is relatively well reported and investigated in the field of cardiac and major non-cardiac orthopedic surgery. According to these reports, POD is associated with greater cost, longer length of hospital stays or institutionalization, more frequent discharge to long-term care facilities, additional complications aside from POD, poor recovery, and mortality 8,19,26) . Although reversible in nature, POD precedes with some cognitive deficits remaining for up to months after surgery, particularly in the elderly 4,21) .…”

A Twin-Study of Genetic Contributions to Hearing Acuity in Late Middle Age

“…Previous studies using single photon emission computed tomography (SPECT) or positron-emission tomography (PET) in delirium describe variable changes in blood flow. For example, delirium tremens is associated with globally increased cerebral perfusion (7), hepatic encephalopathy may result in reductions in temporoparietal and occipital perfusion and either increases or decreases in subcortical perfusion (8)(9)(10)(11)(12), and postcardiotomy delirium is associated with decreased parietooccipital and temporal perfusion (13). Many of these studies are case studies of patients with specific causes of delirium, rather than general medical patients who typically constitute the majority of patients with delirium in the hospital.…”

Spinal Subdural Hemorrhage as a Cause of Post-Traumatic Delirium

“…Thus, the lack of acetylcholine or relative excess of dopaminergic transmission seems to be connected to the development of delirium. The age-dependent decrease of acetylcholine transmission is a physiologic process, and reduced "cholinergic reserve" may be responsible for the significantly higher incidence of delirium among elderly patients 3,6,9) . To attain satisfactory relief of post-traumatic delirium, target behaviors should be divided into those that are amenable to nonpharmacologic (behavioral) intervention versus those that require psychopharmacologic intervention, only after thorough systemic evaluation 12) .…”