Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery.

Abstract

As part of a prospective study of the neurologic and neuropsychological complications of coronary artery bypass graft surgery, 312 patients were compared with a control group of 50 patients undergoing major surgery for peripheral vascular disease. The purpose of comparing the 2 groups was to determine to what extent neurologic complications after heart surgery can be attributed to cardiopulmonary bypass. The 2 groups were similar with respect to age, preoperative neurologic and intellectual status, anesthetic methods, duration of operation, perioperative complications, and time spent in the intensive therapy unit. Certain potential risk factors for cerebrovascular disease were more common in the control than the coronary bypass patients. The important difference between the 2 groups was that only the latter group underwent cardiopulmonary bypass. In this group 191 of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic and neuropsychological complications. By the time of hospital discharge 17% had neurologic disability and 38% had significant neuropsychological symptoms. In the control group 9 of 50 (18%) developed neurologic complications resulting largely from trauma to lower limb sensory nerves. Two patients developed primitive reflexes. Fifteen of 48 (31%) showed neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe intellectual dysfunction was not seen in the control patients in contrast to the 24% thus affected in the coronary bypass group. The difference in frequency and severity of central nervous system complications between the 2 groups is likely to reflect cerebral injury resulting from cardiopulmonary bypass. (Stroke 1987;18:700-707)

Effect of pre-emptive analgesia by continuous femoral nerve block on early postoperative cognitive function following total knee arthroplasty in elderly patients

“…A decrease in the MMSE scale was used to determine the presence of POCD. Previous studies have used a postoperative MMSE score >1 standard deviation below the preoperative score to define POCD (14). In the present study, 1 standard deviation of preoperative MMSE score is 2 points, so a postoperative MMSE score ≥2 points lower than the preoperative score was defined as POCD.…”

Effects of N-acetylcysteine on neurocognitive functions after coronary artery bypass graft surgery

“…Shaw ve ark. [26,27] KABG ameliyatı geçiren hastalarda nörokognitif fonksiyonları ameliyat sonrası 7. günde on test ile değerlendirmişler; hastaların %79'unda en az bir testte, %24'ünde ise en az üç testte nörokognitif fonksiyon kaybı tespit etmişlerdir. Oranlarının bu derece yüksek olmasının nedeni çok sayıda test kullanmaları ve test sonuçlarında açığa çıkan küçük değişiklikleri de anlamlı kabul etmeleri olabilir.…”

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

“…Risk factors associated with patients that cannot be modified are: the advanced age (Shaw et al, 1987;Diijkstra et al, 1996;Roach et al, 1996;Moller et al, 1998;Abildstrom et al, 2000;Stockton et al, 2000;Ancelin et al, 2001;Newman et al, 2001;Canet et al, 2003;Monk et al, 2008), the educational status (Moller et al, 1998;Abildstrom et al, 2000;Ancelin et al, 2001;Newman et al, 2001;Monk et al, 2008) and the genetic polymorphism (considering apolipoprotein E4) (Abildstrom et al, 2004;Heyer et al, 2005;Lelis et al, 2006). The advanced age is associated with a large number of health problems, many of which can be successfully treated by surgical operations.…”