Seminars in cardiothoracic and vascular anesthesia
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The use of cardiopulmonary bypass (CPB) is associated with cerebral microemboli. Cognitive decline after cardiac surgery has therefore always been attributed to the use of CPB. However, randomized studies comparing coronary bypass surgery with and without CPB failed to establish a clear cognitive benefit of avoiding CPB. The aim of this analysis was to systematically review the studies that directly assessed the association between cerebral microemboli and cognitive decline after cardiac surgery. ⋯ This systematic review could neither confirm nor rule out a causal link between emboli from CPB and postoperative cognitive decline.
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Semin Cardiothorac Vasc Anesth · Jun 2010
ReviewNeurocognitive dysfunction following cardiac surgery.
Postoperative neurocognitive decline (POCD) is the most frequently reported form of brain injury in the cardiac surgery setting. Even though most patients recover over a period of several months, recovery is variable and often transient, and early decline may be a marker of neurocognitive dysfunction after several years. ⋯ Large prospective, longitudinal trials with appropriate controls remain necessary to identify how patient characteristics, disease progression, and surgical and anesthetic technique contribute to aging-related neurocognitive decline. This article reviews the current literature on the etiology of POCD following cardiac surgery, discusses strategies to reduce patient risk, and provides some insight into some controversies that merit continued investigation.
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Delirium is defined as a disturbance of consciousness with cognitive changes or perceptual disturbances, which has developed over a short period of time, and is caused by a medical condition or a postsurgical state. Although historically dismissed as an inconvenient and transient problem, recent studies have reported that delirium is associated with more complications, increased length of hospital stay, and higher mortality. ⋯ Management includes treatment of underlying disorders, nonpharmacological measures and symptomatic drug therapy. There is a need for well-designed randomized, double-blind, placebo-controlled trials on drug treatment.
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Semin Cardiothorac Vasc Anesth · Jun 2010
Methodological issues of postoperative cognitive dysfunction research.
Postoperative cognitive dysfunction (POCD) is a subtle impairment of memory, concentration, and speed of information processing. It is a frequent complication following surgery and can have a debilitating effect on patients' recovery and future prognosis. ⋯ There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects, and the interval between test sessions, also influence test results and must be considered when designing and interpreting POCD data.