Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

Abstract

Introduction:The Neurological injury is an important complication after CABG. There is considerable evidence that early postoperative cognitive dysfunction is related to a combination of three factors often associated with CPB: (micro) embolism, hypoperfusion, and the systemic inflammatory response. Intraoperative formation of gaseous emboli and aggregated platelets, atherosclerotic debris, hypoperfusion, hypotension, hyperthermia, hyperglycaemia, surgical trauma, blood loss, Anaesthetic agents, arrhythmia and transfusion all enhance the risk of cognitive dysfunction.There are two types of Neurological injury, Type-I includes stroke, transient ischemic attack and coma and the incidence is approximately 3 to 6 percent. Type-II injury is more subtle and includes impairment of cognitive functions. These defects associated with attention, concentration, short term memory, fine motor function and speed of the mental response. The incidence of neurocognitive impairment after cardiac surgery varies from 20% to 80%. 1 Based on prospective studies, however it is apparent that the incidence of subtle postoperative neurologic and neuropsychological abnormalities is much higher, closer to 50 percent in the first week after cardiac surgery. 2 These apparent high rate of subtle neurologic impairment detected prospectively are in sharp contrast to the considerably lower incidence of stroke after cardiac surgery, reported as 1-5 percent, in several large retrospective series from different centers. 3 There are several reasons for these apparent differences in the reported incidences the timing, thoroughness and the reproducibility of the neurologic examinations, as well as the incorporation of the preoperative assessment for comparison, all determine the sensitivity and Evaluation of Neurocognitive Dysfunction afterCoronary Artery Bypass Surgery p = 0.002 and 25.93 ± 3.11 vs. 26.63 ± 2.50, p = 0.023 respectively

Systematic Review and Pooled Meta-analysis of the Current Status of Coronary Revascularization Surgery in Bangladesh

“…Additionally, the bias in selection of patients was observed in retrospective studies 17,33 which is typical of studies that are retrospective nature. The included cross-sectional 13,29 studies were also devoid of comparative groups and thus had low significance to our study due to their small sample sizes. We determined that the evidence provided by these studies (and the included studies overall) was still of an acceptable quality (Table 1).…”

Liraglutide Nano-Preparation on Perioperative Neurocognitive Dysfunction in Aged Mice

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Acute Kidney Injury After Aortic Arch Surgery: Does the Procedure Make a Difference?

“…3 Neurologic injury also is a dreaded complication of cardiac surgery and is related to factors such as microemboli, hypoperfusion, and an inflammatory response. 4 Gaseous and particulate emboli from atherosclerotic debris from the aortic arch increase the risk of both stroke and neurocognitive dysfunction. Cerebral perfusion deficits from preexisting cerebral vascular disease, hypoperfusion and autoregulation problems, cerebral metabolic problems with hyperglycemia and relative hyperthermia from rewarming, and blood transfusion add to these potential causes.…”