Metabolic disturbance affects postoperative cognitive function in patients undergoing cardiopulmonary bypass

Shirvani, Fariba; Sedighi, Mohsen; Shahzamani, Mehran

doi:10.1007/s10072-021-05308-w

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Glucose dysregulation has been identified as a risk factor for delirium [ 2 , 37 ], but few studies have investigated the link between stress hyperglycemia and delirium. Recent studies on surgical patients reported that perioperative stress-induced hyperglycemia was positively related to postoperative delirium [ 38 – 40 ], which was partly in line with our results. However, most of the aforementioned studies utilized absolute glycemia (i.e., random or fasting glucose) to diagnose stress hyperglycemia without considering the background glucose.…”

Section: Discussionsupporting

confidence: 92%

Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study

et al. 2022

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Background It remains unclear whether stress hyperglycemia is associated with delirium. We performed this cohort study to determine the association between stress hyperglycemia and delirium. Methods We consecutively enrolled patients aged ≥70 years who were admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017. Stress hyperglycemia ratio (SHR) was calculated as fasting blood glucose divided by estimated average glucose derived from glycosylated hemoglobin (HbA1c) and was classified into three tertiles. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. The Cox proportional hazards models were used to assess the association of SHR with delirium. Results Among 487 included patients (mean age 83.0 years, 72.0% male), 50 (10.3%) patients experienced delirium during hospitalization. Compared to the second tertile, both the lowest and the highest SHR tertiles were independently associated with delirium (hazard ratio [HR] 3.71, 95% confidence interval [CI] 1.45-9.51; and HR 2.97, 95% CI 1.29-6.81, respectively). Similar results were found after further adjusting for statin comedication. Multiple-adjusted restricted cubic splines revealed a nonlinear relationship between SHR and delirium (Pnonlinearity=0.04). Adding SHR to conventional risk factors improved the risk prediction of delirium (net reclassification index 0.39, P=0.01; integrated discrimination improvement 0.07, P=0.03). Subgroup analyses indicated that the relationship between SHR and delirium was more apparent in patients with HbA1c <6.5%, with significantly higher HR in the first (3.65, 95% CI 1.11-11.97) and third (3.13, 95% CI 1.13-8.72) SHR tertiles compared to the second tertile, while there was no significant association between SHR and delirium in those with HbA1c ≥6.5%. Conclusions Both lower and higher SHR were associated with increased risk of delirium but only in patients with HbA1c <6.5%. Admission SHR may serve as a promising predictor of delirium, and incorporating this biomarker into prediction algorithms might have potential clinical utility in aiding delirium risk stratification, especially in those with HbA1c <6.5%.

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Section: Discussionsupporting

confidence: 92%

Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study

et al. 2022

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“…Extubation is the process of removing a breathing tube that is inserted into a patient’s airway during surgery to help them breathe. The longer the duration of extubation (the amount of time the breathing tube is in place), the higher the risk of postoperative delirium [ 38 , 39 ]. This is because the tube can cause irritation and inflammation in the airways, which can trigger an inflammatory response in the body that can lead to cognitive issues [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

The role of perioperative sedative anesthetics in preventing postoperative delirium: a systematic review and network-meta analysis including 6679 patients

Huang,

Zhang,

Wang

et al. 2024

BMC Cardiovasc Disord

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Objective Postoperative delirium is a common and debilitating complication that significantly affects patients and their families. The purpose of this study is to investigate whether there is an effective sedative that can prevent postoperative delirium while also examining the safety of using sedatives during the perioperative period. Methods The net-meta analysis was used to compare the incidence of postoperative delirium among four sedatives: sevoflurane, propofol, dexmedetomidine, and midazolam. Interventions were ranked according to their surface under the cumulative ranking curve (SUCRA). Results A total of 41 RCT studies involving 6679 patients were analyzed. Dexmedetomidine can effectively reduce the incidence of postoperative delirium than propofol (OR 0.47 95% CI 0.25–0.90), midazolam (OR 0.42 95% CI 0.17-1.00), normal saline (OR 0.42 95% CI 0.33–0.54) and sevoflurane (OR 0.39 95% CI 0.18–0.82). The saline group showed a significantly lower incidence of bradycardia compared to the group receiving dexmedetomidine (OR 0.55 95% CI 0.37–0.80). In cardiac surgery, midazolam (OR 3.34 95%CI 2.04–5.48) and normal saline (OR 2.27 95%CI 1.17–4.39) had a higher rate of postoperative delirium than dexmedetomidine, while in non-cardiac surgery, normal saline (OR 1.98 95%CI 1.44–2.71) was more susceptible to postoperative delirium than dexmedetomidine. Conclusion Our analysis suggests that dexmedetomidine is an effective sedative in preventing postoperative delirium whether in cardiac surgery or non-cardiac surgery. The preventive effect of dexmedetomidine on postoperative delirium becomes more apparent with longer surgical and extubation times. However, it should be administered with caution as it was found to be associated with bradycardia.

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“…This leads to a rise in the concentration of acidic metabolites such as lactate, which contributes to intracellular acidosis. Lactate may cross the disrupted blood brain barrier and contribute to neurocognitive impairment via excess increases in intracellular calcium concentration, mitochondrial dysfunction, and protein denaturation ( 147 , 148 ). Lastly, hyperglycaemia may disrupt the autonomic regulation of cerebral vasculature, delaying neurocognitive recovery following cardiac surgery ( 148 ).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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Metabolic disturbance affects postoperative cognitive function in patients undergoing cardiopulmonary bypass

Cited by 5 publications

References 27 publications

Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study

Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study

The role of perioperative sedative anesthetics in preventing postoperative delirium: a systematic review and network-meta analysis including 6679 patients

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

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