Key result
Postoperative mild cognitive impairment occurred in 21.1% of patients, all of whom were over 65, underwent valvular surgery, and experienced intraoperative hyperglycemia and cerebral desaturation.
Why the study?
To evaluate adequate cerebral perfusion in patients undergoing cardiac surgery with cardiopulmonary bypass.
Observational (n=19)
Yes
Continuous multimodal neurological monitoring during cardiac surgery with cardiopulmonary bypass can help identify intraoperative factors, such as cerebral desaturation and hypotension, associated with postoperative cognitive impairment.
Suggests intraoperative factors may raise cognitive risk after cardiac surgery; hypothesis-generating and requires prospective validation before practice change.
Objective: to evaluate the adequate cerebral perfusion in patients who underwent cardiac surgery with cardiopulmonary bypass. Methods: an observational, analytical, prospective and multicentric study was conducted. All adults patients scheduled for cardiac surgery with cardiopulmonary bypass were included, with hospital admission at least the day before the intervention, with a negative Pfeiffer test, without communication problems, and with informed consent. Cerebral monitoring with Masimo ROOT 03® was used with encephalogram measurement (4 channels), cerebral oximetry and anesthetic depth. As a pre and postoperative cognitive assessment instrument we used the Pfeiffer test. Results: 19 patients with a mean age of 64.8 ± 11.5 years were included. The postoperative Pfeiffer test showed no cognitive impairment in 78.9% of the cases. While the remaining 21.1% had mild cognitive impairment (1 patient had ischemic damage). In this group, all were valvular patients, older than 65 years of age, and had maximum glycemias greater than 180 mg/dL. In 75% of the patients with cognitive impairment, the baseline SrO2 was less than 57%, there was sustained hypotension at sometime during surgery and it had a decrease of more than 20% of its basal SrO2. Conclusions: Continuous brain monitoring (electroencephalogram, cerebral oxygen saturation, anesthetic depth, suppression rate) during cardiac surgery with cardiopulmonary bypass is a reliable, valid and necessary safety measure to improve the quality of perfusion and surgical patient care.
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Castilla et al. (2019) conducted an observational in Cardiac surgery with cardiopulmonary bypass (n=19). Continuous brain monitoring (EEG, cerebral oximetry, anesthetic depth) was evaluated on Postoperative cognitive impairment assessed by the Pfeiffer test. Postoperative mild cognitive impairment occurred in 21.1% of patients, all of whom were over 65, underwent valvular surgery, and experienced intraoperative hyperglycemia and cerebral desaturation.
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