Rapport sommaire: l’incidence décroissante de l’hyperthermie cérébrale pendant la cardiochirurgie, sept ans d’expérience auprès de 6 334 patients

Corkey, William B.; Phillips-Bute, Barbara; Baudet, Bruno; Mathew, Joseph P.; Newman, Mark F.; Grocott, Hilary P.

doi:10.1007/bf03015774

Cited by 5 publications

(1 citation statement)

References 10 publications

(17 reference statements)

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“…Not only is there evidence for progressive uptake of some of the relevant recommendations (27), there is also evidence (albeit somewhat circumstantial) that progress on risk reduction has been achieved over the period of interest. For example, we used similar measurement methodology and definitions of POCD in two separate neuroprotection studies almost 10 years apart in the same cardiac surgical suite (28,29) and found that the incidence of early deficits in the control group fell from 75% to 41%.…”

Section: Historical Perspectivementioning

confidence: 99%

Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?

Mitchell¹,

Merry²

2015

J Extra Corpor Technol

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From the time an association was perceived between cardiac surgery and post-operative cognitive dysfunction (POCD), there has been interest in arterial microemboli as one explanation. A succession of studies in the mid-1990s reported a correlation between microemboli exposure and POCD and there followed a focus on microemboli reduction (along with other strategies) in pursuit of peri-operative neuroprotection. There is some evidence that the initiatives developed during this period were successful in reducing neurologic morbidity in cardiac surgery. More recently, however, there is increasing awareness of similar rates of POCD following on and off pump cardiac operations, and following many other types of surgery in elderly patients. This has led some to suggest that cardiopulmonary bypass (CPB) and microemboli exposure by implication are non-contributory. Although the risk factors for POCD may be more patient-centered and multifactorial than previously appreciated, it would be unwise to assume that CPB and exposure to microemboli are unimportant. Improvements in CPB safety (including emboli reduction) achieved over the last 20 years may be partly responsible for difficulty demonstrating higher rates of POCD after cardiac surgery involving CPB in contemporary comparisons with other operations. Moreover, microemboli (including bubbles) have been proven harmful in experimental and clinical situations uncontaminated by other confounding factors. It remains important to continue to minimize patient exposure to microemboli as far as is practicable.

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Section: Historical Perspectivementioning

confidence: 99%

Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?

Mitchell¹,

Merry²

2015

J Extra Corpor Technol

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Yawning and thermoregulation

Gallup¹,

Gallup²

2008

Physiology & Behavior

111

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Perioperative Hypothermia: Use and Therapeutic Implications

Mackensen

McDonagh

Warner

2009

Journal of Neurotrauma

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Perioperative cerebral ischemic insults are common in some surgical procedures. The notion that induced hypothermia can be employed to improve outcome in surgical patients has persisted for six decades. Its principal application has been in the context of cardiothoracic and neurosurgery. Mild (32-35 degrees C) and moderate (26-31 degrees C) hypothermia have been utilized for numerous procedures involving the heart, but intensive research has found little or no benefit to outcome. This may, in part, be attributable to confounding effects associated with rewarming and lack of understanding of the mechanisms of injury. Evidence of efficacy of mild hypothermia is absent for cerebral aneurysm clipping and carotid endarterectomy. Deep hypothermia (18-25 degrees C) during circulatory arrest has been practiced in the repair of congenital heart disease, adult thoracic aortas, and giant intracranial aneurysms. There is little doubt of the protective efficacy of deep hypothermia, but continued efforts to refine its application may serve to enhance its utility. Recent evidence that mild hypothermia is efficacious in out-of-hospital cardiac arrest has implications for patients incurring anoxic or global ischemic brain insults during anesthesia and surgery, or perioperatively. Advances in preclinical models of ischemic/anoxic injury and cardiopulmonary bypass that allow definition of optimal cooling strategies and study of cellular and subcellular events during perioperative ischemia can add to our understanding of mechanisms of hypothermia efficacy and provide a rationale basis for its implementation in humans.

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Rapport sommaire: l’incidence décroissante de l’hyperthermie cérébrale pendant la cardiochirurgie, sept ans d’expérience auprès de 6 334 patients

Cited by 5 publications

References 10 publications

Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?

Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?

Yawning and thermoregulation

Perioperative Hypothermia: Use and Therapeutic Implications

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