Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

Background Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery. Methods A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay. Results The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P < 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups. Conclusions In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

Psychological Reports ◽

10.2466/pr0.105.3.921-932 ◽

2009 ◽

Vol 105 (3) ◽

pp. 921-932 ◽

Cited By ~ 17

Author(s):

Judith A. Hudetz ◽

Alison J. Byrne ◽

Kathleen M. Patterson ◽

Paul S. Pagel ◽

David C. Warltier

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Cognitive Impairment ◽

Cardiopulmonary Bypass ◽

Cognitive Dysfunction ◽

Postoperative Delirium ◽

Postoperative Cognitive Dysfunction ◽

Surgical Patients ◽

Nonverbal Memory ◽

Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

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Use of polypeptide neuroprotection for prevention of postoperative cognitive dysfunction after cardiac surgery: a pilot prospective randomized placebo-controlled clinical study

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-4-69-78 ◽

2017 ◽

Vol 21 (4) ◽

pp. 69

Author(s):

M. A. Putanov ◽

M. A. Sokolova ◽

P. I. Lenkin ◽

V. Yu. Slastilin ◽

I. G. Baskakova ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cognitive Dysfunction ◽

Study Design ◽

Cerebral Oxygenation ◽

Plasma Concentrations ◽

Postoperative Cognitive Dysfunction ◽

Cerebral Oximetry ◽

S100b Protein ◽

Control Group

Aim. The study was designed to evaluate the efficacy of polypeptide neuroprotection using brain protein “Cellex” for prevention of postoperative cognitive dysfunction after cardiac surgery. Methods. Our study included 60 patients undergoing elective cardiosurgical operations, who were randomized into two groups. In the “Cellex” group, the patients received 1.0 ml of “Cellex” subcutaneously daily during 8 days, beginning from the preoperative day, while the control group patients were given a saline placebo. The cognitive function was assessed using a Montreal cognitive assessment (MoCA) test on the day before surgery and also at Days 3 and 7 postoperatively. The plasma concentrations of S100b protein were measured before surgery, and at Days 3 and 7. The patients’ gas exchange, hemodynamics and cerebral oxygenation were monitored. In addition, the efficacy of “Cellex” and the severity of cognitive dysfunction were evaluated intraoperatively under cardiopulmonary bypass. Results. The duration of intervention and mechanical ventilation, as well as hemodynamics and cerebral oximetry data did not differ significantly between the groups. There was a transient decline of cognitive functions and an increase in plasma concentration of S100b at Day 3 after surgery in both groups (p<0.05). At Day 7, the MoCA score was still decreased in the control group (p<0.003), but returned to the baseline in the “Cellex” group. These effects became more pronounced after cardiopulmonary bypass. The intraoperative PaCO2 correlated with cerebral oxygenation surgery by the beginning and at the end of surgery (rho = 0.305, p = 0.033 and rho = 0.533; p<0.001). Conclusion. The perioperative use of “Cellex” can attenuate cognitive dysfunction after cardiac surgery, especially when following interventions under cardiopulmonary bypass.Received 25 May 2017. Revised 9 November 2017. Accepted 13 November 2017.Funding: The study was carried out with support of the “Farm-Sintez” company’s grant. The money was spent for purchase of the preparation, the authors’ honoraria and purchase of a kit for determining S100b protein concentration. The sponsors’ support had no impact on the study design and data acquisition, analysis and interpretation. The “Farm-Sintez” company’s representatives were not participating in the preparation and publication of the article.Conflict of interest: The study was carried out with support of the “Farm-Sintez” company’s grant.Author contributions Conception and study design: M.A. Putanov, M.M. Sokolova, P.I. Lenkin, M.Yu. Kirov Data collection and analysis: M.A. Putanov, M.M. Sokolova, P.I. Lenkin, I.G. Baskakova, A.N. Kiriluk, D.N. Kazarinov, K.M. Checkaya, T.S. Isakova, M.A. Rumyanceva, V.Yu. Slastilin Statistical data analysis: M.M. Sokolova Drafting the article: M.A. Putanov, M.M. Sokolova Critical revision of the article: M.Yu. Kirov Final approval of the version to be published: M.A. Putanov, M.M. Sokolova, P.I. Lenkin, V.Yu. Slastilin, I.G. Baskakova, A.N. Kiriluk, D.N. Kazarinov, K.M. Checkaya, T.S. Isakova, M.A. Rumyanceva, M.Yu. Kirov

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Postoperative cognitive dysfunction (POCD) and neuroinflammation associated with cardiac surgery: a review

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc/51-1538435553 ◽

2019 ◽

pp. 136-140

Author(s):

Mohammed Kattan ◽

Abdulaziz Alnimari ◽

Ahmed Siraj ◽

Abdulrahman Alotaibi ◽

Faisal Alsuqati

Keyword(s):

Cardiac Surgery ◽

Cognitive Dysfunction ◽

Postoperative Cognitive Dysfunction

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Faculty Opinions recommendation of Postoperative cognitive dysfunction in older patients with a history of alcohol abuse.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1080869.533801 ◽

2007 ◽

Author(s):

Armin Schubert

Keyword(s):

Alcohol Abuse ◽

Cognitive Dysfunction ◽

Older Patients ◽

Postoperative Cognitive Dysfunction ◽

History Of

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Neurological Complications of Cardiac Procedures

Seminars in Neurology ◽

10.1055/s-0041-1728761 ◽

2021 ◽

Author(s):

Courtney M. Hrdlicka ◽

Jeffrey Wang ◽

Magdy Selim

Keyword(s):

Cardiac Surgery ◽

Cognitive Dysfunction ◽

Postoperative Cognitive Dysfunction ◽

Neurological Complications ◽

Diagnostic Workup ◽

Diagnosis And Management ◽

Percutaneous Interventions ◽

Cardiac Procedures ◽

Appropriate Treatment ◽

Periprocedural Stroke

AbstractNeurological complications after cardiac surgery and percutaneous cardiac interventions are not uncommon. These include periprocedural stroke, postoperative cognitive dysfunction after cardiac surgery, contrast-induced encephalopathy after percutaneous interventions, and seizures. In this article, we review the incidence, pathophysiology, diagnosis, and management of these complications. Improved understanding of these complications could lead to their prevention, faster detection, and facilitation of diagnostic workup and appropriate treatment.

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