Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Özgök, Ayşegül

doi:10.5606/tgkdc.dergisi.2020.18685

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…We found that patients with a history of diabetes or previous cerebral infarction were more likely to develop impaired CA after CPB with MHCA (Table 1). This was consistent with previous work suggesting that diabetes may associate with the occurrence of impaired CA by inducing cerebral microvascular endothelial dysfunction and cardiovascular autonomic neuropathy [31][32][33] . The previous cerebral infarction may weaken or damage the response of CBV to changes in blood pressure [34,35] .…”

Section: Discussionsupporting

confidence: 93%

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Peng

Wei

Zeng

et al. 2021

Preprint

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Backgroundː Impairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its occurrence and associations with outcomes. The objective of this study was to analyze the occurrence of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.Methodsː Sixty-four patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Postoperative complication and in-hospital mortality were compared between patients with normal and impaired CA.Resultsː Of the 64 patients, 19(29.7%) developed new-onset impaired CA after CPB with MHCA. Compared with normal CA patients, those with impaired CA showed a significantly longer duration of rScO2 <55%, and significantly higher rates of in-hospital mortality and postoperative complications (acute kidney injury, delirium, mechanical ventilation > 24h, and respiratory infection). Conclusionsː In our cohort, 29.7% of patients who underwent total aortic arch replacement developed new-onset impaired CA after CPB with MHCA. Impaired CA might be associated with significantly increased rates of postoperative complications and in-hospital mortality. Clinical trial registration: ChiCTR1800014545 with registered date 20/01/2018.

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Section: Discussionsupporting

confidence: 93%

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Peng

Wei

Zeng

et al. 2021

Preprint

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“…Preoperative evaluation is the important part to determine the high risk patients such as diabetics and further examinations like transcranial doppler may be helpful. Transcranial Doppler is a non-invasive ultrasound which provides neuromonitoring and evaluation of the middle cerebral artery flow velocity, which carries 75 to 80% of the carotid artery blood flow that responsible of the cerebral blood flow (13).…”

Section: Discussionmentioning

confidence: 99%

Tiroidektomi Sırasında Semi-Fowler Pozisyonunun Serebral Oksijenizasyona Etkileri

Yaman¹,

Aydın²,

Pehlivanli³

2020

Osmangazi̇ Journal of Medicine

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Patients are positioned with hyperextension of head and neck at Semi-Fowler state during general anaesthesia to facilitate the surgical procedure. We aimed to determine the changes of serebral oxygenation in this position during thyroidectomy surgery. 22 patients were recruited prospective observational study. Cerebral oxygenation were monitored, left and right cerebral regional oxygen saturation were measured continuously. Heart rate, mean arterial pressure, end-tidal carbondioxide were measured and evaluated at baseline, after positioning at 15th, 30th, 90th minutes and after surgery at corrected position. After 90 minutes, significant decrease was seen cerebral oxygenization right side compared to the baseline (p ˂ 0.05). 30th minute cerebral oxygenization right value decreased significantly compared to the 15th minute. 30th minute, cerebral oxygenization left value decreased significantly compared to 15 minutes (p ˃ 0.05). 90th minute cerebral oxygenization left value decreased significantly compared to the 30th minute (p < 0.05). Significant decrease in cerebral oxygen saturation in both cerebral sides had been shown in relation to prolonged surgery time. Cerebral oxygenation was effected by the position given for thyroidectomy surgery. High-risk patients can be detected by regional cerebral oxygen saturation and prevent cerebral ischemia. Precautions should be taken for highrisk patients.

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“…Neurological and neurocognitive impairments are among the most serious of these complications. [ 1 - 3 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 ] Three main mechanisms are held responsible for POND: microembolism, insufficient cerebral perfusion, and systemic inflammatory response. [ 3 , 5 ] The CABG patients are often accompanied by advanced age, carotid artery stenosis, and diabetes mellitus (DM), which may all increase the risk of POND. The incidence of POND in the early postoperative period after CABG varies between 20 and 50%.…”

Section: Introductionmentioning

confidence: 99%

“…Neurological and neurocognitive impairments are among the most serious of these complications. [1][2][3] Postoperative neurocognitive dysfunction (POND), characterized by impaired attention, concentration, and memory with possible long-term effects, frequently occurs following CABG. [4] Three main mechanisms are held responsible for POND: microembolism, insufficient cerebral perfusion, and systemic inflammatory response.…”

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confidence: 99%

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The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

Özhan¹,

Baştopçu²,

Karakaya³

et al. 2021

Turk Gogus Kalp Dama

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Background: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. Methods: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. Results: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). Conclusion: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

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Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

Cited by 3 publications

References 22 publications

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Tiroidektomi Sırasında Semi-Fowler Pozisyonunun Serebral Oksijenizasyona Etkileri

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

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