Yuji Kadoi1, Fumio Goto. 1. Department of Anesthesiology, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Abstract
PURPOSE: Central nervous system complications continue to be major causes of morbidity and mortality after cardiac surgery. The purpose of this study was to identify the risk factors for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery. METHODS: Eighty-eight patients scheduled for elective CABG were studied. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb for the continuous monitoring of jugular venous oxygen hemoglobin saturation (SjvO(2)). The hemodynamic parameters and arterial and jugular venous blood gases were measured during cardiopulmonary bypass (CPB). All patients underwent a battery of neurological and neuropsychological tests one day before the operation and at 6 months after the operation. RESULTS: The incidence of a cognitive decline at 6 months was 24/88 (27.3%). Greater age (P = 0.04), the presence of renal failure (P < 0.001), and diabetes mellitus (P < 0.001) were more frequent in the patients with postoperative cognitive dysfunction at 6 months after the operation than in patients without cognitive dysfunction. Age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0-1.7; P = 0.04), diabetes mellitus (OR, 1.8; 95% CI, 1.2-2.4; P < 0.01), and presence of renal failure (OR, 2.8; 95% CI, 2.4-4.3; P < 0.01) were associated with cognitive impairment at 6 months postoperatively. However, there was no relationship between the presence of atherosclerosis in the ascending aorta and postoperative cognitive dysfunction after CABG surgery. CONCLUSIONS: A greater age, diabetes mellitus, and renal failure were found to be risk factors for development of cognitive impairment at 6 months after CABG with CPB.
PURPOSE:Central nervous system complications continue to be major causes of morbidity and mortality after cardiac surgery. The purpose of this study was to identify the risk factors for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery. METHODS: Eighty-eight patients scheduled for elective CABG were studied. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb for the continuous monitoring of jugular venous oxygen hemoglobin saturation (SjvO(2)). The hemodynamic parameters and arterial and jugular venous blood gases were measured during cardiopulmonary bypass (CPB). All patients underwent a battery of neurological and neuropsychological tests one day before the operation and at 6 months after the operation. RESULTS: The incidence of a cognitive decline at 6 months was 24/88 (27.3%). Greater age (P = 0.04), the presence of renal failure (P < 0.001), and diabetes mellitus (P < 0.001) were more frequent in the patients with postoperative cognitive dysfunction at 6 months after the operation than in patients without cognitive dysfunction. Age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0-1.7; P = 0.04), diabetes mellitus (OR, 1.8; 95% CI, 1.2-2.4; P < 0.01), and presence of renal failure (OR, 2.8; 95% CI, 2.4-4.3; P < 0.01) were associated with cognitive impairment at 6 months postoperatively. However, there was no relationship between the presence of atherosclerosis in the ascending aorta and postoperative cognitive dysfunction after CABG surgery. CONCLUSIONS: A greater age, diabetes mellitus, and renal failure were found to be risk factors for development of cognitive impairment at 6 months after CABG with CPB.
Authors: M F Newman; J L Kirchner; B Phillips-Bute; V Gaver; H Grocott; R H Jones; D B Mark; J G Reves; J A Blumenthal Journal: N Engl J Med Date: 2001-02-08 Impact factor: 91.245
Authors: Shahar Bar-Yosef; Marc Anders; G Burkhard Mackensen; Lian K Ti; Joseph P Mathew; Barbara Phillips-Bute; Robert H Messier; Hilary P Grocott Journal: Ann Thorac Surg Date: 2004-11 Impact factor: 4.330
Authors: J L Rudolph; K A Schreiber; D J Culley; R E McGlinchey; G Crosby; S Levitsky; E R Marcantonio Journal: Acta Anaesthesiol Scand Date: 2010-04-15 Impact factor: 2.105
Authors: Elder Dos Santos Cavalcante; Rosmeiri Magario; César Augusto Conforti; Gerson Cipriano Júnior; Ross Arena; Antonio Carlos C Carvalho; Enio Buffolo; Bráulio Luna Filho Journal: Arq Bras Cardiol Date: 2014-10-28 Impact factor: 2.000