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

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

<p><strong>Aim.</strong> The study was designed to evaluate the efficacy of polypeptide neuroprotection using brain protein “Cellex” for prevention of postoperative cognitive dysfunction after cardiac surgery.<br /><strong>Methods.</strong> 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.<br />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&lt;0.05). At Day 7, the MoCA score was still decreased in the control group (p&lt;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&lt;0.001). <br />Conclusion. The perioperative use of “Cellex” can attenuate cognitive dysfunction after cardiac surgery, especially when following interventions under cardiopulmonary bypass.</p><p>Received 25 May 2017. Revised 9 November 2017. Accepted 13 November 2017.</p><p><strong>Funding:</strong> 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.</p><p><strong>Conflict of interest:</strong> The study was carried out with support of the “Farm-Sintez” company’s grant.</p><p><strong>Author contributions</strong><br />Conception and study design: M.A. Putanov, M.M. Sokolova, P.I. Lenkin, M.Yu. Kirov <br />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 <br />Statistical data analysis: M.M. Sokolova <br />Drafting the article: M.A. Putanov, M.M. Sokolova <br />Critical revision of the article: M.Yu. Kirov <br />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</p>

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

2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
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.

scholarly journals Establish a Nomogram of Cardiac Postoperative Cognitive Dysfunction

2021 ◽  
Vol 24 (2) ◽  
pp. E320-E326
Author(s):  
Naxin Xie ◽  
Sunang Yan ◽  
Xuejun Sun ◽  
Haibo Liu
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Dysfunction ◽  
Odds Ratio ◽  
Early Stage ◽  
Univariate Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
High Sensitivity ◽  
Control Group ◽  
Internal Validation ◽  
Wbc Count

Objectives: Cardiac postoperative cognitive dysfunction (c-POCD) is a common complication. This article established a nomogram by analyzing preoperative and intraoperative data to help identify high-risk patients and take effective management for prevention of c-POCD in early stage. Measurements and main results: A total of 265 patients were enrolled in this study, 27 of whom were diagnosed as cardiac postoperative cognitive dysfunction (c-POCD). Patients were divided into a control group and c-POCD group. Univariate analysis suggested that gender, smoking, drinking history, hypertension, white blood cell (WBC) count, aspartate aminotransferase (AST), high-sensitivity troponin (hs-CRP), arrhythmia, left atrial diameter (LAD), cardiopulmonary bypass (CPB) time, and the ascending aortic block (AAB) time were correlated with postoperative cognitive dysfunction after cardiac surgery. Multivariate regression analysis indicated that CPB time (P = 0.0015, OR (95% CI) = 6.696 (2.068-21.675), hypertension (P = 0.0098, OR (95%CI) = 3.776 (1.377-10.356), WBC count (P = 0.0227, OR (95%CI ) = 3.358 (1.184-9.522), AST (P = 0.0128, OR (95%CI) = 3.966 (1.340-11.735), and arrhythmia (P = 0.0017, OR (95%CI) = 5.164 (1.855-14.371) were the independent risk factors of cognitive dysfunction after cardiac surgery and used to establish a nomogram for clinical use. The initial C-index of the nomogram was 0.8182 and good calibration. Corrected C-index value of 0.793 was reached after internal validation. The area under ROC curve of this model was 0.8188 (95%CI: 0.7185-0.9190). The positive odds ratio (PLR) was 1.21 (95%CI: 1.1-1.3), and the negative odds ratio (NLR) was 0.18 (95%CI: 0.03-1.3). Conclusion: This nomogram incorporating the CPB time, hypertension, WBC count, AST, and arrhythmia to predict the risk of c-POCD. The internal validation shows a good forecasting effect.

scholarly journals Brain oximetry is not a good monitor on reducing neurological complications after cardiac surgery

2019 ◽  
Vol 38 (2) ◽  
pp. 81 ◽  
Author(s):  
Seyed Mohammadreza Amouzegar Zavareh ◽  
Hasan Araghizade ◽  
Nahid Eskandari ◽  
Marzieh Lak
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Cerebral Oxygenation ◽  
Statistical Significance ◽  
Intervention Group ◽  
Neurological Complications ◽  
Cerebral Oximetry ◽  
Control Group ◽  
Brain Oxygenation ◽  
Significant Difference

Background<br />Cerebral deoxygenation is related to several adverse systemic consequences. We aimed to assess the effect of noninvasive monitoring of cerebral oxygenation on reducing neurological complications after cardiac surgery.<br /><br />Methods <br />In this randomized clinical trial, subjects were randomized into two groups: intervention group (111 subjects with monitoring of cerebral oximetry) and control group (112 subjects without any monitoring of cerebral oximetry). Monitoring of regional cerebral oxygen saturation (rScO2) was performed in the intervention group without any monitoring of cerebral oxygenation. The rScO2 was not recorded in the control group and no specific treatments were employed. Any neurological complications such as hallucinations, delirium, stroke, and length of stay in ICU after surgery were recorded. A p-value less than 0.05 was used as a cut-off for statistical significance.<br /><br />Results<br />After surgery, in the intervention group one (1/111=0.09%) patient suffered from stroke and one patient had delirium, while in the control group three patients had stroke and three (3/112=2.6%) had delirium. There was no significant difference between the two groups regarding complications (p=0.527). The length of stay in ICU was 3.49 ± 0.96 days in the case group and 3.40 ± 0.80 days in the control group and there was no significant difference in the two groups (p=0.477).<br /><br />Conclusion<br />Monitoring of rScO2 does not seem to be a good monitor for brain oxygenation. Further studies are needed to judge the usefulness of rScO2 for monitoring brain oxygenation.

scholarly journals Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

2020 ◽  
Author(s):  
Shahzad Shaefi ◽  
Puja Shankar ◽  
Ariel L. Mueller ◽  
Brian P. O’Gara ◽  
Kyle Spear ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Cognitive Assessment ◽  
Older Patients ◽  
Postoperative Cognitive Dysfunction ◽  
Neurocognitive Function ◽  
Secondary Outcomes ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

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 &lt; 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

scholarly journals Neurological Complications of Cardiac Procedures

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.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

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