Quantified pre-operative neurological dysfunction predicts outcome after coronary artery bypass surgery

Semrau, Joanna S; Scott, Stephen H.; Hamilton, Andrew; Petsikas, Dimitri; Payne, Darrin; Bisleri, Gianluigi; Saha, Tarit; Boyd, J. Gordon

doi:10.1007/s40520-019-01184-9

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Baseline rSO 2 will be determined in the first 5 min prior to induction of anaesthesia. Our earlier work demonstrated that subtle and undiagnosed impairments prior to surgery detected by the Kinarm can highly predict postoperative neurological dysfunction 30. This and other studies have strongly emphasised the importance of including baseline functioning, as it can account for a significant amount of variance in neurological outcome following cardiac surgery 4 31.…”

Section: Methods and Analysismentioning

confidence: 88%

Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

et al. 2019

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IntroductionPatients undergoing cardiac surgery may experience both short-term and long-term postoperative neurological problems. However, the underlying cause of this impairment is unclear. Regional cerebral oxygen saturation (rSO2) levels may play a role in the development of acute dysfunction, known as postoperative delirium, in addition to longer term outcomes after cardiac surgery. Yet the degree of impairment has been difficult to define, partly due to subjective methods of assessments. This study aims to fill this knowledge gap by determining the relationship between rSO2, postoperative delirium and long-term neurological outcome after cardiac surgery using quantitative robotic technology.Methods and analysis95 patients scheduled for elective cardiac surgery will be recruited for this single-centre prospective observational study. Patients will be assessed before as well as 3 and 12 months after their surgery using the Kinarm End-Point Lab and standardised tasks. Intraoperatively, rSO2 and other haemodynamic data will be collected for the duration of the procedure. Following their operation, patients will also be screened daily for delirium during their hospital stay.Ethics and disseminationThis study has been approved by the Health Sciences Research Ethics Board at Queen’s University (DMED-1672–14). The results of this study will be published in a peer-review journal and presented at international and/or national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication.Trial registration number NCT04081649

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Section: Methods and Analysismentioning

confidence: 88%

Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

et al. 2019

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“…Similarly, from the KINARM test, there were non-significant impairments on the reverse visually guided reaching task, object hit and avoid tasks, ball on bar tasks and arm positioning match tasks. Notably, pre-operative cognitive performance accounted for 82.2% of variance in post-operative performance [111]. Bennett et al 2020 found that their NIRS protocol (commencing intervention when rSO2 dropped below baseline on room air) did not reduce neurocognitive dysfunction post-operatively prior to discharge or at 6 months.…”

Section: Monitoring Of Cerebral Perfusion Via Near-infrared Spectroscopymentioning

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 was no difference between the groups in regard to the time to intensive care unit discharge, time to hospital discharge, brain injury markers (S100), myocardial injury markers (serum troponin T) or kidney injury markers ( 113 ). Furthermore, Semrau et al ( 114 ) demonstrated that pre-operative cognitive impairment is a stronger predictor of POCD compared to intraoperative rSO2 desaturations. They measured neuropsychological function using a standardised assessment known as the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the KINARM Standard Tests on the KINARM Endpoint robot.…”

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

confidence: 99%

“…Similarly, from the KINARM test, there were non-significant impairments on the reverse visually guided reaching task, object hit and avoid tasks, ball on bar tasks and arm positioning match tasks. Notably, pre-operative cognitive performance accounted for 82.2% of variance in post-operative performance ( 114 ). Bennett et al found that their NIRS protocol (commencing intervention when rSO2 dropped below baseline on room air) did not reduce neurocognitive dysfunction post-operatively prior to discharge or at 6 months.…”

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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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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Quantified pre-operative neurological dysfunction predicts outcome after coronary artery bypass surgery

Cited by 8 publications

References 26 publications

Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

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