Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting

Song, Zhe; Fu, Paul; Chen, Mingying; Bi, Qing

doi:10.1080/01616412.2016.1187830

Cited by 5 publications

(3 citation statements)

References 21 publications

(18 reference statements)

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“…Mean arterial pressure has been shown to need to be maintained between 80 and 90 mmHg during CPB, without intraoperative pressure dropping more than 32 mmHg [51], because brain hypoperfusion may lead to POCD [52]. Similarly, surgical manipulation during beating-heart surgery may reduce cardiac output; therefore, decreasing systemic blood pressure might reduce the brain perfusion index [12,53]. Although hypothermia is associated with decreased oxygen consumption and carbon dioxide production, studies have shown opposite effects of spontaneous hypothermia (32–35°C) during surgical procedures on cognitive functions [54,55], probably because of the rewarming effect after weaning off CPB [35].…”

Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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The growing number of publications concerning postoperative cognitive decline (POCD) after cardiac surgery is indicative of the health-related and economic-related importance of this intriguing issue. Significantly, the reported POCD incidence over the years has remained steady due to various unresolved challenges regarding the examination of this multidisciplinary topic. In particular, a universally accepted POCD definition has not been established, and the pathogenesis is still vaguely understood. However, numerous recent studies have focused on the role of the inflammatory response to a surgical procedure in POCD occurrence. Therefore, this traditional narrative review summarizes and evaluates the latest findings, with special attention paid to the difficulties of defining POCD as well as the involvement of inflammation in POCD development. We searched the MEDLINE, Scopus, PsycINFO and CENTRAL databases for the best evidence, which was classified according to the Oxford Centre for Evidence-based Medicine. To our knowledge, this is the first narrative review that identified class-1 evidence (systematic review of randomized trials), although most evidence is still at class-2 or below. Furthermore, we revealed that defining POCD is a very controversial matter and that the inflammatory response plays an important role in the mutually overlapping processes included in POCD development. Thus, developing the definition of POCD represents an absolute priority in POCD investigations, and the inflammatory response to cardiac surgery merits further research.

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Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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“…Cognitive impairment after cardiac surgery is driven by many preoperative, intraoperative, and postoperative risk factors. 51 Some modifiable factors include management of vital signs, [51][52][53] surgical manipulation, 54 sedation management, 55 and reduction of postoperative complications. 54 The interventions identified in this review primarily focused on maintaining adequate cerebral oxygenation and cognitive function but seldom on these other risk factors.…”

Section: Discussionmentioning

confidence: 99%

Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery

et al. 2022

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BackgroundMore than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery.ObjectiveThe aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery.MethodsCINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022.ResultsNineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment.ConclusionsThis review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.

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“… 24 , 25 Decreased cerebral oxygenation is a risk factor for POCD and is associated with delirium and prolonged hospitalization, particularly in elderly patients. 26 , 27 Pneumoperitoneum and 30° Trendelenburg position may not affect cerebral oxygenation within 2 hours because of physiological compensation mechanisms. 28 However, cerebrovascular autoregulation gradually changes with prolonged pneumoperitoneum in the 45° Trendelenburg position.…”

Section: Discussionmentioning

confidence: 99%

S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study

Öztürk

Kavakli

Arslan

et al. 2020

Brazilian Journal of Anesthesiology (English Edition)

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Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting

Abstract: Abnormal CT perfusion is a significant risk factor for postoperative cognitive dysfunction, and has the most impact on visuospatial/executive and naming functions.

Cited by 5 publications

References 21 publications

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery

S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study

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