Neuropsychologische und psychopathologische Veränderungen nach kardiochirurgischen Eingriffen

Abstract

Neuropsychological and neuropsychiatric disorders following open heart surgery are estimated to occur in as many as 80 per cent of all patients. They have been recognised from the very beginning of modern heart surgery. Despite a huge amount of scientific literature, data concerning incidence, the phenomenology and duration of symptoms diverge. This finding may be explained by heterogeneous aetiopathogenetic concepts and methodological and terminological problems associated with the investigation of postoperative delirium or neuropsychological and psychopathological sequelae of cardiac surgery. Nowadays, most authors agree in respect of a multifactorial pathogenesis of cognitive deficits following cardiac surgery. Factors influencing the psychopathological and neuropsychological outcome of cardiac surgery can be divided into pre-, intra- and postoperative variables. Advanced age, degree of cardiovascular impairment and other case histories, as well as history of drug abuse, are those preoperative variables that may be responsible for a postoperative cognitive decline. The predictive value of personality traits (depression and/or anxiety), however, is most controversial. Among the intraoperative variables related to the postoperative cognitive state, are e.g. the type of operation and technical procedure (micro-/macroembolism due to the way of oxygenation, pulsatile/-non-pulsatile flow) and duration of extracorporeal circulation. In the postoperative period, the duration of intubation or ICU stay and related variables (like sleep or sensory deprivation/hyperstimulation) were identified as significant predictors of neuropsychological and psychopathological alterations. Modern research focusses on neurobiochemical markers of brain injury which may serve as early predictors of a postoperative cognitive decrease. These parameters may indicate an early postoperative diagnosis and neuroprotective treatment in patients at risk.

Is Preoperative Anxiety and Depression Associated with Onset of Delirium After Cardiac Surgery in Older Patients? A Prospective Cohort Study

“…2,5,9 The latter factor could be indicative of greater intraoperative and postoperative complexity, which may in turn affect neurological outcomes, including onset of delirium. 3,5 Baseline cognitive dysfunction and older age are well-known risk factors for delirium, 2,5 but those variables were not associated with delirium, possibly because of the small sample size and the use of medical record data for diagnosing preexisting dementia, the latter of which could have led to misclassification.…”

“…Although it can appear at all ages, elderly hospitalized patients are particularly at risk. [1][2][3][4][5][6] Special attention must be paid to delirium after cardiac surgery, because the syndrome is associated with adverse outcomes, including higher rates of postoperative complications, longer hospital stay, and higher mortality. 2 Furthermore, evidence from other populations shows that delirium is associated with risk of nursing home placement and a higher dependence in activities of daily living (ADLs).…”

“…7,8 Numerous studies have investigated pre-, intra-, and postoperative risk factors, and all concluded that the causes of delirium after cardiac surgery are multifactorial. [2][3][4][5]9 Not surprisingly, high incidence rates of preoperative anxiety (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40).6%) and depressive symptoms (16-43%) are reported before cardiac surgery, [10][11][12] yet the influence of anxiety on occurrence of postoperative delirium remains controversial and has been examined in two noncardiac surgery studies 13,14 but not in cardiac surgery patients. Prior studies in non-cardiac surgery suggested that depression was a predictor of delirium, but its relationship with cardiac surgery needs to be determined.…”

Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia Increases Delirium after Cardiac Surgery

“…1–8 The causes of postoperative delirium remain unclear, but are thought to include pain, sleep deprivation, anesthetic and narcotic effects, concomitant medications, surgical stress, and the inflammatory response to surgery. 2,9–19 …”

Biopsychosoziale Auswirkungen herzchirurgischer Eingriffe – eine relevante konsiliarpsychiatrische Herausforderung

“…Die mittels neuropsychologischer Testverfahren zu erfassenden subtilen kognitiven Leistungsdefizite in der Folge von CABG sind in den vergangenen zehn Jahren zunehmend bedeutsam geworden, wenn es um die Bewertung der Ergebnisqualität kardiochirurgischer Operationen unter EKZ bei Patienten mit koronarer Herzkrankheit ging [66]. Zumeist umfassen diese subtilen kognitiven Leistungsdefizite in der Folge von CABG Störungen von Gedächtnisfunktionen und Aufmerksamkeitsprozessen [5].…”