Objectives: Cardiac surgery involving cardiopulmonary bypass is associated with neurologic deterioration. Several interventions, including anesthetic techniques, have been designed to limit ischemic brain damage and have been evaluated in animals. Markers of neurologic injury may facilitate the assessment of these interventions in humans.Design: A blinded randomized prospective study comparing 2 anesthetic techniques (one sufentanilbased, the other ketamine and midazolam-based) in patients undergoing cardiac surgery. Quantitative electroencephalography was used to detect postoperative neurologic injury.
Setting: Major teaching hospital.Participants: Forty-two patients aged 18 to 70 years undergoing cardiac surgery.Interventions: Patients were anesthetized with either a sufentanil-based or a ketamine and midazolambased technique for cardiac surgery with cardiopulmonary bypass. Quantitative electroencephalography was performed preoperatively as well as 5 to 6 days postoperatively.
Measurements and Main Results:Quantitative electroencephalography outcome did not differ (p > 0.05) between the 2 groups. It showed significant deterioration between preoperative and postoperative assessments with a decrease in faster and an increase in slower frequencies. In addition, the alpha attenuation index decreased. This may reflect a decrease in alertness. Both the intergroup comparisons and the assessment of individual changes failed to reveal significant differences between the anesthetic techniques. The adjuvant use of isoflurane correlated with less deterioration of quantitative electroencephalographic variables.
Conclusions:The use of either sufentanil-based or ketamine and midazolam-based anesthetic techniques for cardiac surgery with cardiopulmonary bypass had no effects on a marker of postoperative neurologic injury (ie, quantitative electroencephalography).THE MANIFESTATIONS of cerebral injury after cardiac surgery, to some extent ascribable to the effects of cardiopulmonary bypass (CPB), include postoperative delirium, stroke, and cognitive changes.
IntroductionTracheal intubation is accompanied by an increased blood pressure and heart rate. The aim of this study was to find the most important source of this haemodynamic response, namely laryngoscopy or intubation.
MethodA standard induction technique was used for all patients. Eighty patients were randomly allocated to one of two groups, one group to undergo laryngoscopy followed by intubation (Group I), and the other laryngoscopy only of duration similar to intubation (Group L). Blood pressure and heart rate were recorded in the ward, before induction of anaesthesia and one, two, three, and four minutes after instrumentation.
ResultsThe instrumentation times did not differ significantly (p = 0.20). Over time mean arterial pressures were significantly higher in Group I than in Group L (p = 0.038). Over time the ratios of mean blood pressure and heart rate relative to the preoperative heart rate were significantly greater in Group I than in Group L (p < 0.01).
ConclusionBlood pressures and heart rates were significantly greater after laryngoscopy followed by intubation than after laryngoscopy of the same duration not followed by intubation. The induction technique, consisting of lignocaine, alfentanil, and propofol, may have attenuated expected increases in blood pressure but not increases in heart rate after intubation.
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