Neurological Damage Related to Cardiac Surgery

Carrascal, Yolanda; Peral, Á.L. Guerrero

doi:10.1097/nrl.0b013e3181bd602b

Cited by 35 publications

(5 citation statements)

References 198 publications

(222 reference statements)

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“…Interestingly, inflammatory mediators (for example, interleukin-1, interleukin-6, and tumor necrosis factor alpha (TNF-α)) can contribute to delirium [37,38]. As cardiac surgery with extracorporeal circulation induces a systemic inflammatory reaction [39,40], patients with sleep-associated respiratory disorders may be particularly susceptible to neurological injury following cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

et al. 2014

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IntroductionDelirium is a frequent complication after cardiac surgery. Although various risk factors for postoperative delirium have been identified, the relationship between nocturnal breathing disorders and delirium has not yet been elucidated. This study evaluated the relationship between sleep-disordered breathing (SDB) and postoperative delirium in cardiac surgery patients without a previous diagnosis of obstructive sleep apnea.MethodsIn this prospective cohort study, 92 patients undergoing elective cardiac surgery with extracorporeal circulation were evaluated for both SDB and postoperative delirium. Polygraphic recordings were used to calculate the apnea-hypopnea index (AHI; mean number of apneas and hypopneas per hour recorded) of all patients preoperatively. Delirium was assessed during the first four postoperative days using the Confusion Assessment Method. Clinical differences between individuals with and without postoperative delirium were determined with univariate analysis. The relationship between postoperative delirium and those covariates that were associated with delirium in univariate analysis was determined by a multivariate logistic regression model.ResultsThe median overall preoperative AHI was 18.3 (interquartile range, 8.7 to 32.8). Delirium was diagnosed in 44 patients. The median AHI differed significantly between patients with and without postoperative delirium (28 versus 13; P = 0.001). A preoperative AHI of 19 or higher was associated with an almost sixfold increased risk of postoperative delirium (odds ratio, 6.4; 95% confidence interval, 2.6 to 15.4; P <0.001). Multivariate logistic regression analysis showed that preoperative AHI, age, smoking, and blood transfusion were independently associated with postoperative delirium.ConclusionsPreoperative SDB (for example, undiagnosed obstructive sleep apnea) were strongly associated with postoperative delirium, and may be a risk factor for postoperative delirium.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0477-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

et al. 2014

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“…In cardiac surgery, when the following three major events are present, there is greater risk of death: onset of respiratory tract infection (RTI), preoperative cerebrovascular accident (CVA), and dialysis-dependent renal failure (DDRF) [ 6 - 9 ] . Besides being associated with higher mortality rates, those events are the leading cause of readmission to the intensive care unit, increasing hospital costs [ 10 ] .…”

Section: Introductionmentioning

confidence: 99%

Use of EuroSCORE as a predictor of morbidity after cardiac surgery

Andrade¹,

Neto²,

Andrade³

2014

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveTo evaluate the use of the EuroSCORE as a predictor of postoperative morbidity after cardiac surgery.MethodsWe retrospectively analyzed the charts of 900 patients operated on and admitted to the intensive care unit postoperatively at the Royal Portuguese Hospital of Recife. We included all patients with complete medical records, excluding those who died during surgery, underwent transplantation or correction of congenital heart disease. We evaluated the development of respiratory infection, cerebrovascular accident, and dialysis-dependent renal failure, and the EuroSCORE was compared in terms of the three complications using the Mann-Whitney test. The calibration model for predicting the morbidities being studied was evaluated using the test set of Homer-Lemeshow goodness. The accuracy of the model was assessed using the area under the ROC curve (AUROC).ResultsThe model showed good calibration in predicting respiratory infection, acute renal failure and stroke (P=0.285, P=0.789, P=0.45, respectively), with good accuracy for respiratory infection (AUROC=0.710 and P<0.001) and dialysis-dependent renal failure (AUROC=0.834 and P<0.001), but no accuracy to predict stroke (AUROC=0.519). The high-risk patients were more likely to develop respiratory infection (OR=9.05, P<0.001) and dialysis-dependent renal failure (OR=39.6, P<0.001). The probability of developing respiratory infection and dialysis-dependent renal failure was less than 10% with EuroSCORE up to 7 and more than 70% with EuroSCORE greater than 15.ConclusionEuroSCORE proved to be a good predictor of major postoperative morbidity in cardiac surgery: respiratory and dialysis-dependent renal failure.

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“…Kerusakan otak perioperatif adalah salah satu komplikasi yang paling serius dari operasi dan anestesi, mengakibatkan defisit neurologis baru pasca operasi termasuk transient ischemic attack (TIA), stroke dan postoperative cognitive dysfunction (POCD). [1][2][3][4] Kerusakan otak adalah cedera yang menyebabkan rusaknya atau memburuknya sel otak yang disebabkan oleh berbagai kondisi seperti trauma kepala, pasokan oksigen yang tidak memadai, infeksi atau perdarahan intrakranial. 1,2 Dengan cedera otak yang parah, orang tersebut mungkin mengalami perubahan hidup dan mereka akan mengalami gangguan kognitif, perilaku dan fisik.…”

Section: Pendahuluanunclassified

“…Satu dari 10 pasien akan mengalami POCD yang berakhir lebih dari 3 bulan setelah operasi. [3][4][5][6][7] Perkiraan bahwa anestetik dan sedatif adalah neurotoksik yang reversible, kemungkinan benar pada kebanyakan pasien yang berumur antara 3 tahun sampai 60 tahun. Akan tetapi, yang berumur diatasnya, berada pada risiko yang lebih besar karena sistim yang memungkinkan pemulihan memiliki kapasitas yang berkurang.…”

Section: Pendahuluanunclassified

Konsep GHOST- CAP untuk Proteksi Otak Perioperatif pada Cedera Otak Traumatik

Bisri

2022

JNI

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Brain damage is an injury that causes damage or worsening of brain cells caused by various conditions such as head trauma, inadequate oxygen supply, infection or intracranial hemorrhage. Brain protection is a preemptive measure of therapeutic interventions to improve neurological outcomes in patients at risk of cerebral ischemic, while brain resuscitation refers to therapeutic interventions that begin after the occurrence of ischemic. The target is ischemic therapy and reducing neuronal injury. Perioperative brain damage is one of the most serious adverse complications of surgery and anesthesia, resulting in new postoperative neurological deficits. The concept of GHOST-CAP, an acronym for Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure and PaCO2, can be used in the postoperative period. G: The target level of glucose is between 80 and 180 mg/dL. H: hemoglobin threshold is 7-9 g/dL. O: oxygen, target SpO2 between 94 and 97%. S: Sodium concentration affects brain volume, sodium levels up to 155 mEq/L are tolerable. T: temperatures regulated to optimize cellular function, but core temperatures > 38.0°C should be avoided. C: patient comfort, including pain control, agitation, anxiety, and chills. A: Arterial blood pressure is the main determinant of cerebral blood flow (CBF), maintaining an mean arterial pressure (MAP) of 80 mmHg and cerebral perfusion pressure (CPP) of 60 mmHg. P: Acute changes in PaCO2 cause CBF changes, PaCO2 not to be less than 35 mmHg. This paper examines the GHOST-CAP concept for perioperative brain protection, whether adequate or should be supplemented

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Neurological Damage Related to Cardiac Surgery

Cited by 35 publications

References 198 publications

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

Use of EuroSCORE as a predictor of morbidity after cardiac surgery

Konsep GHOST- CAP untuk Proteksi Otak Perioperatif pada Cedera Otak Traumatik

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