Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Jun 2010
ReviewIs there a future for neuroprotective agents in cardiac surgery?
This article gives an overview of neuroprotective drugs that were recently tested in clinical trials in cardiac surgery. Also, recommendations are given for successful translational research and considerations for management during cardiac surgery.
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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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The life saving benefits of cardiac surgery are frequently accompanied by negative side effects such as stroke, that occurs with an incidence of 2%-13% dependent to type of surgery. The etiology is most likely multifactorial with embolic events considered as main contributor. Although stroke presents a common complication, no guidelines for any routine use of pharmacological substances or non-pharmacological strategies exist to date. ⋯ Stroke remains as significant complication after cardiac surgery. Non-pharmacological strategies allow perioperative caregivers to detect injurious events and to ameliorate stroke and its sequelae. Considering the multi-factorial etiology though, stroke prevention will likely have to be addressed with an individualistic combination of different strategies and substances.
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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.