Neuropsychologic testing within 18 hours after cardiac surgery

Statistical and conceptual issues in defining post-operative cognitive dysfunction

“…Furthermore, the precise etiology of POCD or the risk factors that contribute to its manifestation are still not known. Importantly, POCD is distinct from delirium and other confusional states that may occur as an acute response to treatment [2], can be differentiated from the acute effects of medication in the immediate post-operative period [3] and appears less severe than dementia. Patients with POCD may not perceive that their cognition has changed and the extent to which POCD affects activities of daily living (ADL) is not known.…”

“…POCD is then inferred on the basis of deterioration in performance on the cognitive test from the pre-operative to post-operative assessment. The time between pre-and post-operative assessments is variable and may range from hours [3] to years [36]. Fig.…”

“…In the short term after CABG surgery, an incidence of POCD of 30% at 18 h post operatively and persisting in 7% of subjects for 5 days has been reported [3]. Shaw et al found that 38% of their CABG sample had 'significant neuropsychological symptoms' (p. 700) at discharge [48].…”

Are we using our brains? Diagnosis of postoperative cognitive dysfunction

“…The European Resuscitation Council [4] and American Heart Association [5] published their own new guidelines on the same day, and other countries will follow suit shortly, in a demonstration of co-operation and transparency that is possibly unparalleled elsewhere in the medical scientific community. The Resus(UK) 2010 guidelines are based on the International Consensus on CPR Science with Treatment Recommendations (CoSTR) [6,7], developed by the International Liaison Committee on Resuscitation (ILCOR), currently co-chaired by Jerry Nolan of the UK and Vinay Nadkarni of the USA. ILCOR was founded in 1992, and its membership comprises the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian and New Zealand Committee on Resuscitation, the Inter-American Heart Foundation, the Resuscitation Council of Asia and the Resuscitation Council of Southern Africa.…”

“…Subtle brain injury following cardiac surgery has since been the subject of much research. The incidence of cognitive deterioration has been examined at various time points, from 18 h postoperatively [7], to discharge [8][9][10], to up to 5 years postoperatively [11][12][13]. Associated risk factors [14][15][16] have also been explored, with major advances being made in noncardiac surgical patients [14,15].…”