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Role of Intraoperative Neuromonitoring to Predict Postoperative Delirium in Cardiovascular Surgery.
Al-Qudah, Abdullah M; Ta'ani, Omar Al; Thirumala, Parthasarathy D; Sultan, Ibrahim; Visweswaran, Shyam; Nadkarni, Neelesh; Kiselevskaya, Victoria; Crammond, Donald J; Balzer, Jeffrey; Anetakis, Katherine M; Shandal, Varun; Subramaniam, Kathirvel; Subramanium, Balachundhar; Sadhasivam, Senthilkumar.
Afiliación
  • Al-Qudah AM; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Ta'ani OA; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Thirumala PD; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: thirumalapd@upmc.edu.
  • Sultan I; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Visweswaran S; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Nadkarni N; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Kiselevskaya V; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Crammond DJ; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Balzer J; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Anetakis KM; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Shandal V; Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Subramaniam K; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Subramanium B; Department of Anesthesiology, Critical Care & Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
  • Sadhasivam S; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Cardiothorac Vasc Anesth ; 38(2): 526-533, 2024 Feb.
Article en En | MEDLINE | ID: mdl-37838509
OBJECTIVE: Postoperative delirium (POD) can occur in up to 50% of older patients undergoing cardiovascular surgery, resulting in hospitalization and significant morbidity and mortality. This study aimed to determine whether intraoperative neurophysiologic monitoring (IONM) modalities can be used to predict delirium in patients undergoing cardiovascular surgery. DESIGN: Adult patients undergoing cardiovascular surgery with IONM between 2019 and 2021 were reviewed retrospectively. Delirium was assessed multiple times using the Intensive Care Delirium Screening Checklist (ICDSC). Patients with an ICDSC score ≥4 were considered to have POD. Significant IONM changes were evaluated based on a visual review of electroencephalography (EEG) and somatosensory evoked potentials data and documentation of significant changes during surgery. SETTING: University of Pittsburgh Medical Center hospitals. PARTICIPANTS: Patients 18 years old and older undergoing cardiovascular surgery with IONM monitoring. MEASUREMENTS AND MAIN RESULTS: Of the 578 patients undergoing cardiovascular surgery with IONM, 126 had POD (21.8%). Significant IONM changes were noted in 134 patients, of whom 49 patients had delirium (36.6%). In contrast, 444 patients had no IONM changes during surgery, of whom 77 (17.3%) patients had POD. Upon multivariate analysis, IONM changes were associated with POD (odds ratio 2.12; 95% CI 1.31-3.44; p < 0.001). Additionally, baseline EEG abnormalities were associated with POD (p = 0.002). CONCLUSION: Significant IONM changes are associated with an increased risk of POD in patients undergoing cardiovascular surgery. These findings offer a basis for future research and analysis of EEG and somatosensory evoked potential monitoring to predict, detect, and prevent POD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Monitorización Neurofisiológica Intraoperatoria / Delirio del Despertar Límite: Adolescent / Adult / Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Asunto de la revista: ANESTESIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Monitorización Neurofisiológica Intraoperatoria / Delirio del Despertar Límite: Adolescent / Adult / Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Asunto de la revista: ANESTESIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos