Psychiatric Complications of Open-Heart Surgery

Heller, Stanley S.; Frank, Kenneth A.; Malm, James R.; Bowman, Frederick O.; Harris, Paul D.; Charlton, M. H.; Kornfeld, Donald S.

doi:10.1056/nejm197011052831903

Cited by 131 publications

(38 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sleep deprivation has been suggested as a risk factor for delirium in critically ill patients. Using staff observations, without objective methods, there was a higher prevalence of delirium among sleep-deprived patients [103,104]. Delirious patients were reported to have irregular patterns of melatonin release [59] and disrupted circadian rhythms, resulting in fragmented sleepwake cycles and nighttime awakenings [105].…”

Section: Potential Implications Of Sleep Deprivation and Disruptionmentioning

confidence: 99%

Sleep in acute care units

BaHammam

2006

Sleep Breath

View full text Add to dashboard Cite

Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium. Over the past few years, many studies have endeavored to objectively assess sleep in the ACUs, as well as the effect of mechanical ventilation and circadian rhythm changes critically ill patients. At this time, therefore, it is important to review published data regarding sleep in ACUs, in order to improve the knowledge and recognition of this problem by health care professionals. We have therefore reviewed the methods used to assess sleep in ACUs, factors that may affect sleep in the ACU environment, and the clinical implications of sleep disruption in the ACU.

show abstract

Section: Potential Implications Of Sleep Deprivation and Disruptionmentioning

confidence: 99%

Sleep in acute care units

BaHammam

2006

Sleep Breath

View full text Add to dashboard Cite

show abstract

“…1 Despite these advances, however, postoperative neurological morbidity remains a frequent sequel to operations involving cardiopulmonary bypass (CPB). Numerous studies have incriminated pump-generated microemboli as a major factor in these neurological sequelae 2 -3 while other reports have emphasized the role of adverse situational aspects of recovery such as lack of sleep and sensory deprivation.…”

Section: Additional Abstract Hypotension Electroencephalographymentioning

confidence: 99%

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

Stockard

Bickford

Myers

et al. 1974

Stroke

View full text Add to dashboard Cite

HypotensionInduced Changes in Cerebral Function During Cardiac Surgery• In a series of 75 patients undergoing cardiac operations with the assistance of cardiopulmonary bypass (CPB), 15 patients were subjected to relatively large hypotensive stresses during CPB as measured by the depth and duration of the fall in cerebral perfusion pressure. Of these 15 patients, eight manifested cerebral dysfunction postoperatively ranging from temporary exacerbation of pre-existing focal neurological deficits to irreversible coma. In each of these eight cases, EEG disturbances which first appeared at the time of hypotensive episodes during CPB persisted postoperatively and correlated with the nature and evolution of the clinical deficit. In two of the patients who did not regain consciousness postoperatively, neuropathological studies revealed bilateral laminar cortical necrosis, primarily involving cerebral cortex in one case and cerebellar cortex in the other, with accentuation in arterial border zones. Of seven other patients who suffered comparable exposures to hypotension during CPB, none evidenced cerebral dysfunction postoperatively. The most important determinants of this selective vulnerability to low extracorporeal perfusion pressure appeared to be the "reperfusion" pressure established after the hypotensive episode, postoperative blood pressure and cardiac output, and brain temperature at the time of the hypotension. Advanced age and history of cerebrovascular insufficiency were the greatest risk factors among patient variables. Despite these advances, however, postoperative neurological morbidity remains a frequent sequel to operations involving cardiopulmonary bypass (CPB). Numerous studies have incriminated pump-generated microemboli as a major factor in these neurological sequelae 2 -3 while other reports have emphasized the role of adverse situational aspects of recovery such as lack of sleep and sensory deprivation. Additional Key Words -5Other investigators who correlated histological evidence of ischemic anoxia following CPB with extracorporeal perfusion pressure have suggested that hypotension during CPB may also contribute to CNS dysfunction following cardiac surgery. "10 However, in none of these studies was the intraoperative blood pressure recorded continuously and, in the only one in which the EEG was monitored during bypass, 9 the EEG findings were not discussed. Thus, there was no direct evidence that low perfusion pressures were responsible for the ischemia which produced the lesions in these studies.From the Departments of Neurosciences, Surgery and Anesthesiology, University of California, San Diego, La Jolla, California 92037.More direct evidence was provided in a preliminary study in which six of seven patients having severe hypotensive episodes during CPB developed irreversible or slowly resolving EEG abnormalities during the episodes which later correlated with clinical or pathological evidence of cerebral damage. 11Although the important role of intraoperative hypotension in the neur...

show abstract

“…Increasing age of over 50 years notably increases the risk.3 Senile patients may show a deterioration of postoperative psychological functioning without a lucid interval. 9 Viewpoints regarding the influence of gross preopera¬ tive psychological aberrations (psychosis or family history of psychosis) vary, and it is difficult to assess this factor. However, personality styles or modes of coping, with less than usual flexibility under stress, are seen to correlate with delirium postoperatively.13 Patients with depression, functional psychosomatic disease, sleep disturbance, or history of habitual drug use have generally less than aver¬ age coping ability.…”

Section: Preoperative Factors Associated With Deliriummentioning

confidence: 99%

The Psychiatrist in the Surgical Intensive Care Unit

Nadelson¹

1976

Arch Surg

View full text Add to dashboard Cite

Psychiatric Complications of Open-Heart Surgery

Cited by 131 publications

References 14 publications

Sleep in acute care units

Sleep in acute care units

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

The Psychiatrist in the Surgical Intensive Care Unit

Contact Info

Product

Resources

About