Effects of cerebral oxygen changes during coronary bypass surgery on postoperative cognitive dysfunction in elderly patients: a pilot study

Şahan, Cenk; Sungur, Zerrin; Çamcı, Emre; Sivrikoz, Nükhet; Sayın, Ömer Ali; Gürvıt, Hakan; Şentürk, Mert

doi:10.1016/j.bjane.2017.10.006

Cited by 10 publications

(39 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have examined the relationship between intraoperative rSO 2 and postoperative neurological complications, particularly neurocognitive outcomes. Desaturation of rSO 2 increased the risk of postoperative cognitive dysfunction, and was associated with postoperative delirium and prolonged intensive care unit (ICU) and hospital stay [ 29 , 30 ]. Colak’s [ 31 ] study proved that intraoperative rSO 2 monitoring and measures to correct cerebral oxygen desaturation in a timely manner have resulted in a better cognitive outcome of patients who underwent coronary artery bypass grafting.…”

Section: Discussionmentioning

confidence: 99%

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Zhao

Wang

et al. 2021

Med Sci Monit

View full text Add to dashboard Cite

Background This study aimed to determine the effects of alveolar recruitment maneuver (RM) on cerebral oxygen saturation and cerebral blood velocity in patients undergoing carotid endarterectomy (CEA) before clamping of the carotid artery. Material/Methods In this crossover exploratory study, all patients were randomized to undergo an RM (30 cmH 2 O of continuous airway pressure for 30 s) and a “sham” maneuver (SM; 5 cmH 2 O for 30 s), followed by an alternative intervention after a 5-min equilibration period. Near-infrared spectroscopy (NIRS) was used to monitor regional cerebral oxygen saturation (rSO 2 ), and transcranial Doppler ultrasonography (TCD) to evaluate blood velocity of the middle cerebral artery (V-MCA). Changes in rSO 2 , V-MCA, mean arterial pressure (MAP), and heart rate (HR) in response to the 2 interventions were compared. Results A total of 59 patients underwent the study procedure. RM reduced rSO 2, V-MCA, MAP, and HR, but these variables slightly changed during SM. A significant drop in rSO 2 was observed immediately after RM compared with the baseline value (68.51±4.4% vs 64.12±5.15%; P <0.001). The decrease in rSO 2 was higher during the RM than during the SM (−6±4% vs 1±2%; P <0.001). Similarly, change in V-MCA was more significant in response to RM than SM (−26±19% vs 19±16%; P <0.001). The V-MCA value changed from 39 cm/s to 29 cm/s after RM. In addition, V-MCA of the ipsilateral to the surgical side decreased more obviously than the contralateral side (−26±19% vs −20±17%; P =0.001). Conclusions An RM at 30 cmH 2 O of continuous airway pressure for 30 s decreased rSO 2 and V-MCA. In addition, MAP and HR were affected.

show abstract

Section: Discussionmentioning

confidence: 99%

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Zhao

Wang

et al. 2021

Med Sci Monit

View full text Add to dashboard Cite

show abstract

“…[22] In our previous studies, we also used the second definition in cardiac surgery patients. [34,35] The third point may be that our test battery cannot be considered as a conventional "comprehensive" test battery since it was specially designed to be practical for use by an anesthesiologist (G.O), who was supervised by a behavioral neurologist (H.G). However, we think that this was not a major flaw, as incidence rates of POCD were similar to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Orhun

Sungur

Koltka

et al. 2019

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

BACKGROUND:Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention. METHODS:Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesia was combined with GA. Patients' cognitive function was assessed before and one week after surgery using a neuropsychological test battery. POCD was defined as a drop of one standard deviation from baseline on two or more tests. RESULTS:A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups, except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p<0.001, respectively). The incidence of POCD was comparable between groups (26% in GI and 24% in GII). Memory performance, visuospatial functions, and language skills tests were significantly higher in GII compared to GI. CONCLUSION:General anesthesia and epidural analgesia combined with general anesthesia resulted in similar POCD in elderly patients undergoing abdominal surgery. However, in combined anesthesia group memory, language skills and visuospatial functions appeared to be better preserved. Effective pain control might contribute to preventing cognitive decline in some domains.

show abstract

“…For early POCD (defined as 1–7 days), six observational 8 , 11 , 14–21 (60%) and two interventional 22–26 (40%) studies found an association between cerebral desaturations and POCD. For late POCD (defined as 1–6 months), one 15 , 19 , 20 (25%) observational and none of four 24–28 (0%) of the interventional studies found a relationship. Most studies of POCD evaluated an early time point and a late time point, but the times of evaluation fluctuated.…”

Section: Cerebral Oximetry In Cardiac Surgerymentioning

confidence: 99%

“…For early POCD (defined as 1-7 days), six observational 8,11,[14][15][16][17][18][19][20][21] (60%) and two interventional [22][23][24][25][26] (40%) studies found an association between cerebral desaturations and POCD. For late POCD (defined as 1-6 months), one 15,19,20 (25%) observational and none of four [24][25][26][27][28] | 5421…”

Section: Neurocognitive Outcomesmentioning

confidence: 99%

A comprehensive review of cerebral oximetry in cardiac surgery

Moore

Aljure

2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background Patients who undergo cardiac surgery are at increased risk of stroke, postoperative cognitive decline, and delirium. These neurocognitive complications have led to increased costs, intensive care unit stays, morbidity, and mortality. As a result, there is a significant push to mitigate any neurological complications in cardiac surgery patients. Near‐infrared spectroscopy to measure regional cerebral oxygen saturations has gained consideration due to its noninvasive and user‐friendly nature. Cerebral oximetry desaturations during cardiac surgery have been linked to an array of adverse clinical outcomes. However, the most effective intraoperative interventions to protect this vulnerable patient population have yet to be ascertained. Aim of Study To provide a comprehensive summary of the intraoperative management for cerebral oximetry desaturations during cardiac surgery. The review highlights clinical outcomes from cerebral oximetry use to quantify the importance of identifying cerebral desaturations during cardiac surgery. The review then interrogates possible interventions for cerebral oximetry desaturations in an effort to determine which interventions are most efficacious and to enlighten possible areas for further research. Methods A narrative review of randomized controlled trials, observational studies, and systematic reviews with metanalyses was performed through August 2021. Results There is significant heterogeneity among patient populations for which cerebral oximetry monitoring has been studied in cardiac surgery. Further, the definition of a clinically significant cerebral desaturation and the assessment of neurocognitive outcomes varied substantially across studies. As a result, metanalysis is challenging and few conclusions can be drawn. Cerebral oximetry use during cardiac surgery has not been associated with improvements in neurocognitive outcomes, morbidity, or mortality to date. The evidence to support a particular intervention for an acute desaturation is equivocal. Conclusions Future research is needed to quantify a clinically significant cerebral desaturation and to determine which interventions for an acute desaturation effectively improve clinical outcomes.

show abstract

Effects of cerebral oxygen changes during coronary bypass surgery on postoperative cognitive dysfunction in elderly patients: a pilot study

Cited by 10 publications

References 31 publications

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

A comprehensive review of cerebral oximetry in cardiac surgery

Contact Info

Product

Resources

About