Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting

Yuan, Shuai; Lin, Hong

doi:10.21470/1678-9741-2018-0165

Cited by 36 publications

(37 citation statements)

References 73 publications

(61 reference statements)

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“…Postoperative cognitive dysfunction (POCD) is one of the most common complications after coronary artery bypass grafting (CABG) [1]. POCD comprises a wide range of cognitive functions, including long-term memory, abstract generalization ability, mental concentration and analysis of knowledge applying ability, and thus lowers quality of life and increases mortality [2].…”

Section: Introductionmentioning

confidence: 99%

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Wan

Luo

et al. 2020

Bioscience Reports

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We assessed the relationship between red blodd cell distribution width (RDW) and postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG) in patients who usually had obvious hemodynamic changes. We enrolled 362 coronary heart disease patients who received CABG. POCD was assessed through neuropsychological examination at 21 days after operation. Demographics, history of diseases, blood biochemical parameters and perioperative data were collected. The receiver operating characteristic (ROC) curve was used to find the best cut-off value of RDW for diagnosis of POCD. Logistic regression was used to explore the relationship between RDW and POCD. The 21-day incidence of POCD in patients receiving CABG was 27.1% (98/362). The RDW of POCD patients was significantly higher than in the non-POCD patients (17.4 vs. 13.2). The sensitivity and specificity of RDW for predicting POCD were 82.7 and 64.8%, respectively. The POCD patients also tended to be older and had higher fasting plasma glucose, hypersensitive c-reactive protein, tumor necrosis factor-α, white blood cell levels and longer surgery time. No significant differences were found in other parameters. The 21-day neuropsychological test results were better in the POCD patients than the non-POCD patients. After adjustment of potential factors, the preoperative high RDW was still associated with an increased risk of POCD (odds ratio (OR) = 2.52, 95% confidence interval (CI): 1.28–4.31). Our study indicates that preoperative RDW is significantly elevated in POCD patients receiving CABG. The elevated preoperative RDW is associated with an increased risk of POCD and preoperative RDW can be an independent predictor of POCD.

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Section: Introductionmentioning

confidence: 99%

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Wan

Luo

et al. 2020

Bioscience Reports

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“…Однако в некоторых работах продолжают получать результаты, свидетельствующие об отсутствии статистически значимых различий. Существует мнение, что подобное противоречие основано на неоднородности критериев включения, сопутствующих заболеваний у пациентов, а также подходов к определению ПОКД [12]. Так, вывод о наличии ПОКД может основываться на различных принципах: варьирование результатов тестов на ≥1 стандартное отклонение, ухудшение показателей не менее чем на 20% в не менее чем 20% тестов, усреднение показателей с использованием Z-статистики.…”

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Posthypoxic encephalopathy in patients undergoing coronary artery bypass surgery: clinical, neuropsychological, and neuroimaging aspects

Portik

Tsarevskaya

Efimtsev

et al. 2019

RJTAO

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Posthypoxic encephalopathy is a frequent complication after coronary artery bypass surgery (CABG), which includes stroke, early postoperative delirium, and postoperative cognitive dysfunction (PCD). The more pronounced prevalence and severity of the latter during surgery using extracorporeal circulation are currently being discussed.Objective: to analyze various types of cerebral dysfunction in patients undergoing CABG and to determine the role of perioperative factors in its development.Patients and methods. The investigation enrolled 53 patients who had undergone elective CABG for coronary heart disease. Group 1 included 20 patients who had undergone beating-heart surgery; Group 2 comprised 33 patients, in whom CABG had been performed using extracorporeal circulation (ECC). Neuropsychological testing and brain magnetic resonance imaging (MRI) (structural and functional techniques) were carried out.Results and discussion. Posthypoxic encephalopathy was diagnosed in 10 and 67% of patients in Group 1 and 2, respectively (p=0.05); these were precisely all the three types of brain dysfunction which were observed in Group 2 patients. Factors, such as over 70 years of age; median level of education; smoking; body mass index >30 kg/m2 ; ejection fraction <50%; class III effort angina; >210-min surgery duration; >55-min aortic ligation; and >115-min ECC, showed a statistically significant association with the onset of PCD (p<0.05). In Group 2, MRI revealed a weaker positive functional relationship of the medial prefrontal cortex with the posterior cingulate gyrus (<0.005); 18% of patients were found to have acute ischemic zones.Conclusion. Surgical myocardial revascularization using ECC is associated with a greater likelihood of PCD than beating-heart CABG. The factors that favored the development of PCD, such as increased age, low preoperative cognitive status, smoking, and long-term use of ECC, were identified when applying ECC.

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“…Its clinical manifestations include cognitive dysfunction, personality change, and memory loss, mental disorders, and social impairment (2). It may cause loss of self-care ability and Alzheimer's disease in serious case (3). Because of the long anesthesia duration and the severe surgical stress, the risk of POCD in elderly patients is incredibly increased (4).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intraoperative Dexmedetomidine on Cognitive Dysfunction After Surgery: A Updated Meta-Analysis

Yin¹,

Li²,

Xun³

et al. 2021

Preprint

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BackgroundPostoperative cognitive dysfunction (POCD) is one of the most common. Neuroprotective effects of dexmedetomidine(DEX) are reported in previous studies but evidence regarding the POCD is still unclear. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials(RCTs) which utilized DEX with general anaesthesia perioperatively.MethodFour online databases (PubMed, Embase, the Cochrane Library, and CNKI) were used to find relevant RCTs to conduct systematic analysis. All studies comparing the incidence of POCD or MMSE score between the DEX group and the placebo or comparator group in patients undergoing general anaesthetic surgery were eligible for inclusion. Based on the inclusion and exclusion criteria, the studies were selected. This meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference (SMD) and 95% CIs for continuous data as effective measures.ResultsIn total of 21 studies were included in this meta-analysis. The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR=0.36, 95% CI 0.24-0.54),third (OR=0.45,95% CI 0.33–0.61) and seventh (OR=0.40,95% CI 0.26–0.60) postoperative days; the MMSE scores in DEX group were higher than the control group on the first (SMD=1.24, 95% CI 1.08-1.41), third(SMD= 1.09, 95%CI 0.94-1.24) and seventh (SMD=3.28, 95% CI 1.51-5.04) postoperative days. ConclusionsIntraoperative DEX use can ameliorate the POCD of patients who received surgical operations under general anesthesia, and effectively reduce the incidence of POCD and improve MMSE score.

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Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting

Cited by 36 publications

References 73 publications

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

Posthypoxic encephalopathy in patients undergoing coronary artery bypass surgery: clinical, neuropsychological, and neuroimaging aspects

The Effect of Intraoperative Dexmedetomidine on Cognitive Dysfunction After Surgery: A Updated Meta-Analysis

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