Early Postoperative Cognitive Dysfunction and Blood Pressure During Coronary Artery Bypass Graft Operation

Gottesman, Rebecca F.; Hillis, Argye E.; Grega, Maura A.; Borowicz, Louis M.; Selnes, Ola A.; Baumgartner, William A.; McKhann, Guy M.

doi:10.1001/archneur.64.8.noc70028

Cited by 63 publications

(31 citation statements)

References 10 publications

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“…35,36 The true incidence of stroke after CABG is likely underestimated for several reasons. Because post-CABG stroke is more likely to be caused by embolization and relative hypotension during cardiopulmonary bypass, 6,8,10 most patients develop multiple strokes in arterial watershed territories. 6 Multiple small infarcts are more likely to present with global encephalopathy rather than a focal neurologic deficit.…”

Section: Resultsmentioning

confidence: 99%

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Statin use and neurologic morbidity after coronary artery bypass grafting

Koenig¹,

Grega²,

Bailey³

et al. 2009

Neurology

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Section: Resultsmentioning

confidence: 99%

“…3,10 Together, these factors suggest that stroke and encephalopathy lie on a spectrum of ischemic injury after CABG.…”

Section: Resultsmentioning

confidence: 99%

Statin use and neurologic morbidity after coronary artery bypass grafting

Koenig¹,

Grega²,

Bailey³

et al. 2009

Neurology

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“…There is level-2 evidence that suggests that maintaining perfusion pressure at more physiological levels during CPB (80-90 mmHg) is associated with less early POCD and delirium [36], whereas an intra-operative decline in mean arterial pressure of > 32 mmHg from the preoperative baseline is associated with lower mini-mental state examination scores postoperatively [37]. However, a study using single photon positron-emission computed tomography failed to show significant correlations between changes in regional and global cerebral blood flow, and POCD [38].…”

Section: Altered Cerebral Perfusion and Oxygenationmentioning

confidence: 99%

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

Harten¹,

2012

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SummaryPostoperative cognitive dysfunction is receiving increasing attention, particularly as it mainly affects the (growing) elderly population. Until recently, cognitive deficits after cardiac surgery were thought to be caused by physiological disturbances associated with the cardiopulmonary bypass technique. Although the technique of 'off-pump' coronary revascularisation may potentially be associated with improved outcome, long-term follow-up studies have failed to demonstrate a significant reduction in the incidence of postoperative cognitive dysfunction. The focus of research is thus shifting from cardiopulmonary bypass to other factors common to both techniques, such as surgery, anaesthesia and patient-related predisposing factors. Priming of the immune system by ageing and atherosclerosis may result in an exaggerated systemic and cerebral inflammatory response to cardiac surgery and anaesthesia, causing neuronal loss or dysfunction resulting in cognitive dysfunction. We briefly discuss the evidence for cardiopulmonary bypass-related neuronal injuries in adult cardiac surgery patients, and review the evidence that immune priming is a key factor in the pathogenesis of cognitive dysfunction after cardiac surgery.

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“…To date, studies examining associations between surgery and delirium have investigated microemboli migration [149][150][151], hypoperfusion [64,137,[152][153][154], inflammatory responses [155][156][157], changes in hormone levels [158][159][160][161], and local and general anesthesia [64,133,162,163]. Gottesman and colleagues [152] hypothesized that a drop in the mean arterial pressure may put patients at risk for early cognitive dysfunction. Moreover, elderly patients are characterized by a normal ageing process with a reduction in organ function and altered pharmacokinetics and pharmacodynamics [164].…”

Section: Surgical Factors and Postoperative Cognitive Dysfunctionmentioning

confidence: 99%