Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 1996
ReviewTechniques for avoiding neurologic injury during adult cardiac surgery.
The mechanisms and pathophysiology of perioperative neurologic injury are reviewed. The principle mechanisms of the ischemic injury are gaseous and particulate emboli and hypoperfusion caused by cerebrovascular occlusive disease. The contribution of the cardiopulmonary bypass circuit to the development of ischemic injury is discussed. ⋯ Atherosclerosis of the ascending aorta is a major risk factor for perioperative neurologic injury. Methods of detection and management are thoroughly described. Prevention of embolization from intracardiac debris and clot is described.
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J. Cardiothorac. Vasc. Anesth. · Jan 1996
ReviewCerebral emboli and cognitive outcome after cardiac surgery.
There have been major advancements in cardiac surgery over the past two decades, with a concomitant decrease in mortality and major morbidity. However, several recent studies have demonstrated that cardiac surgery poses significant risk for negative neurologic and neuropsychologic outcome. Although very few patients die as a result of cardiac surgery, more than two thirds of the patients demonstrate evidence of neuropsychologic dysfunction postoperatively. ⋯ If both are important, their relative significance must be established, then one prevented and the effects of the other treated. This report discusses the methodology for detecting cerebral emboli during cardiac surgery. The incidence and severity of neuropsychologic deficits after cardiac surgery are discussed, as well as emboli in relation to composition and time of occurrence and their effect on neuropsychologic outcome.
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J. Cardiothorac. Vasc. Anesth. · Jan 1996
ReviewAdverse neurologic events: risks of intracardiac versus extracardiac surgery.
Intracardiac operations such as valve replacements have typically carried a higher risk (4.2% to 13%) of overt central nervous system outcome, compared with coronary artery bypass grafting (CABG) procedures (0.6% to 5.2%). This is likely owing to the increased risk of macroembolization of air or particulate matter from the surgical field during intracardiac surgery. The periods of highest risk for emboli are during aortic cannulation and especially during release of aortic clamps and weaning from bypass. ⋯ Patients having an intracardiac procedure combined with a CABG procedure may be at particularly high risk for adverse neurologic outcome. For all cardiac surgical patients, there is some cause for optimism in that risk may be minimized by improved assessment (e.g., intraoperative transesophageal or epiaortic echocardiographic scanning of the ascending aorta to identify patients at risk) and monitoring (e.g., detection of embolic phenomena, using transesophageal echocardiography or transcranial Doppler technology). Furthermore, in the future, development and testing of more ideal cerebroprotective drugs may allow amelioration of neurologic injury, either by pretreating all patients at risk, or possibly even by delaying treatment until after the suspected occurrence of an insult.