Risk Factors for Postoperative Encephalopathies in Cardiac Surgery

Post-hypoxic encephalopathy is a brain damage manifested by neurological, neuropsychiatric, and mental disorders, which is caused by a reduction in cerebral blood flow and by a resultant effect of an episode of hypoxia of various etiology and duration. This complication is most characteristic of patients who have undergone cardiac surgery in view of the high prevalence and severity of clinical manifestations, worse quality of life, the longer length of hospital stay, and the higher cost of treatment and rehabilitation. To determine the individual management tactics for such patients, combining both successful surgical treatment, by reducing perioperative stress, and prevention of cerebral complications, it is necessary to analyze the patterns of their development. The role of pathophysiological risk factors, including preoperative, perioperative and postoperative ones, for posthypoxic encephalopathy, is considered. Its preoperative risk factors include age, gender, concomitant diseases, education level, and cognitive functions before surgery, cardiac morphofunctional changes, and depressive disorders. There are surgery-related (type and duration of anesthesia, operating-suite temperatures, and hyperglycemia) and postoperative (pain syndrome after surgical intervention, sleep disorders, and the environment) risk factors. Emphasis is placed on the technical characteristics of on-pump operations, among which there are cerebral hypoperfusion, microembolism, non-pulsatile flow, and duration of extracorporeal circulation. Classifications of cerebral complications are presented. Different types of brain dysfunction are analyzed to assess their incidence rates, clinical features, and dynamics in the postoperative period.

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Posthypoxic encephalopathy in patients after cardiac surgery: etiological, pathogenetic, and clinical aspects (a literature review)

Алексеева

Portik

Топузова

2018

Nevrologiâ, nejropsihiatriâ, psihosomatika

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Consciousness Disorders after Elective Surgery in Patients with Cerebrovascular Insufficiency

Лихванцев¹,

Ильин²,

Шмелева³

et al. 2015

rmt

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Цель исследования -изучить влияние церебральной «гипоксемии» на показатели нейроповреждения, основываясь на диагностике послеоперационных когнитивных нарушений и показателей маркера нейро повреждения белка S100b, изучить взаимосвязь различных послеоперационных когнитивных расстройств. Материал и методы. Исследование проведено у 48 больных не кардиохирургического и не нейрохирургического профиля с подтвержденным церебро ва скулярным заболеванием, оперированных в условиях тотальной внутривенной анестезии на основе пропофола и то тальной миоплегии. Уровень белка S100b в крови определяли после события церебральной «гипоксемии», выявляе мой транкраниальной оксиметрией. Послеоперационный делирий диагностировали методом ICU CAM; послеоперационную когнитивную дисфункцию -на основании Монреальской шкалы когнитивной дисфункции в сро ки: 7 дней, 1 месяц, 3 месяца, 6 месяцев, 1 год, -используя контрольную группу, выполнена стандартизация этих по казателей в Z оценки. Результаты. Церебральная десатурация привела к развитию ранних послеоперационных рас стройств: и делирия, и дисфункции, -в 72,7 % случаев. Показатели церебральной сатурации умеренно, но достоверно коррелировали с нейропсихологическими показателями на 30 сутки исследования и в 3 месяца послеопе рационного периода, а также, но уже сильнее, с уровнем белка S100b. Вероятность послеоперационных когнитивных расстройств в зависимости от показателей белка S100b достоверно предсказана в моделях логистической регрессии и ROC анализа. Частота ранней и стойкой когнитивной дисфункции статистически значимо различалась у больных с предшествующим делирием, в модели логистической регрессии, достоверно предсказана связь этого события и выра женности нейропсихологических показателей на 7 сутки послеоперационного периода. Заключение. У больных с це ребро васкулярными заболеваниями эпизоды церебральной гипоксемии опасны. При их возникновении повышается вероятность развития послеоперационных когнитивных расстройств, в том числе длительных. Ранним предиктором послеоперационных когнитивных расстройств является уровень белка S100b выше порогового значения в 0,26 нг/мл. Ключевые слова: церебро васкулярные заболевания, не кардиохирургические операции, послеоперационный дели рий, послеоперационная когнитивная дисфункция, церебральная оксиметрия, белок S100b.Objective: to study the impact of cerebral hypoxemia on the indicators of neuroinjury, by relying on the diagnosis of post operative cognitive impairments, and the neuroinjury marker S100b protein and to examine the relationship of postopera tive cognitive mpairments. Subjects and methods. Forty eight non cardiac surgical and non neurosurgical patients with verified cerebrovascular disease, who had been operated on under total intravenous anesthesia with propofol and total myoplegia, were examined. Blood S100b protein levels were determined after cerebral hypoxemia detectable by transcra

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The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)

Симонов

Тюрин

Прямиков

et al. 2018

Obŝaâ reanimatologiâ

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The article summarizes the international experience of using different types of anesthesia for the surgical treatment of carotid artery lesions. The anesthesiology support of surgery on the carotid basin includes general and combined anesthesia of various types. The regional anesthesia is a separate field in the carotid surgery. The paper presents the advantages and disadvantages of each anesthetic technique. The recent publications show the superiority of regional anesthesia in terms of its cost-effectiveness, less frequent use of temporary intraluminal shunt, the possibility to constant monitoring of patient’s neurological status throughout the operation, and lower incidence of neurologic and cardiac complications. Complications of the regional anesthesia and the methods of their correction are described in detail. There is still no consensus about the choice of the optimal type of anesthesia for carotid endarterectomy, hence further large-scale randomized trials are needed.

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Risk Factors for Postoperative Encephalopathies in Cardiac Surgery

Cited by 4 publications

References 25 publications

Posthypoxic encephalopathy in patients after cardiac surgery: etiological, pathogenetic, and clinical aspects (a literature review)

Posthypoxic encephalopathy in patients after cardiac surgery: etiological, pathogenetic, and clinical aspects (a literature review)

Consciousness Disorders after Elective Surgery in Patients with Cerebrovascular Insufficiency

The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)

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