Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study.

BACKGROUND: Neurologic deficits after cardiac surgery are common complications. Aim of this prospective observational pilot study was to investigate the incidence of postoperative cognitive deficit (POCD) after cardiac surgery, provided that relevant decrease of cerebral oxygen saturation (cSO2) is avoided during cardiopulmonary bypass. METHODS: cSO2 was measured by near infrared spectroscopy in 35 patients during cardiopulmonary bypass. cSO2 was kept above 80% of baseline and above 55% during anesthesia including cardiopulmonary bypass. POCD was tested by trail making test, digit symbol substitution test, Ray's auditorial verbal learning test, digit span test and verbal fluency test the day before and 5 days after surgery. POCD was defined as a decline in test performance that exceeded - 20% from baseline in two tests or more. Correlation of POCD with lowest cSO2 and cSO2 - threshold were determined explorative. RESULTS: POCD was observed in 43% of patients. Lowest cSO2 during cardiopulmonary bypass was significantly correlated with POCD (p = 0.015, r2 = 0.44, without Bonferroni correction). A threshold of 65% for cSO2 was able to predict POCD with a sensitivity of 86.7% and a specificity of 65.0% (p = 0.03, without Bonferroni correction). CONCLUSIONS: Despite a relevant decrease of cerebral oxygen saturation was avoided in our pilot study during cardiopulmonary bypass, incidence of POCD was comparable to that reported in patients without monitoring. A higher threshold for cSO2 may be needed to reduce the incidence of POCD.

Postoperative neurocognitive function and microembolus detection in patients undergoing neck dissection: a pilot study.

BACKGROUND AND OBJECTIVE: Patients undergoing oncologic neck dissection may have many of the risk factors for carotid artery stenosis, thus predisposing them to perioperative cerebral ischaemic events. The present study was designed to investigate development of postoperative neurocognitive dysfunction in these patients. METHODS: Twenty-six patients were assessed the day before surgery and 48 h and 12 months after surgery using a comprehensive neuropsychological test battery. Cognitive performance was compared with a matched control group to account for the practise effect associated with repeated testing. Doppler ultrasonography was used to detect intraoperative cerebral microembolism. S100beta protein values were evaluated before and immediately after anaesthesia. RESULTS: On the second postoperative day, 26.9% of patients undergoing neck dissection had postoperative neurocognitive deficit (POCD), defined as a total deficit score of 2SD worse than the mean performance in the control group. Microemboli were found only in the neck dissection group. S100beta levels were significantly higher after neck dissection (Wilcoxon signed ranked test: P<0.001). After 12 months, the incidence of POCD was similar in both groups. CONCLUSION: POCD was detectable only after neck dissection in the early postoperative period accompanied by increased incidence of microembolism and protein S100beta levels, but not 12 months after surgery.

Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study.

BACKGROUND: Postoperative cognitive dysfunction (POCD) in elderly patients after noncardiac surgery is a common problem. The noble gas xenon has been demonstrated to exert substantial neuroprotective properties in animal studies. Therefore, this study was designed to assess POCD after xenon anesthesia in comparison to propofol in elderly patients undergoing major noncardiac surgery. METHODS: After approval of the local ethical committee was obtained, 101 patients (American Society of Anesthesiologists physical status I-III; age, 65-83 yr) undergoing elective abdominal or urologic surgery (duration, > 2 h) were enrolled into this randomized, double-blinded controlled pilot study. Patients received anesthesia with sufentanil and either propofol or xenon and were assessed before treatment and 1, 6, and 30 days after treatment using a neuropsychological test battery based on previous studies investigating POCD. RESULTS: There were no significant differences in terms of age, American Society of Anesthesiologists status, education, duration of surgery, administered analgetics, and preoperative neurocognitive status between study groups. POCD as classified was present in 22 patients (44%) of the xenon group versus 25 patients (50%) of the propofol group 1 day after treatment, in 6 xenon patients (12%) versus 9 propofol patients (18%) 6 days after treatment, and in 3 xenon patients (6%) versus 6 propofol patients (12%) 30 days after treatment. These differences were not statistically significant. CONCLUSION: Postoperative impairment of neurocognitive function was observed in a substantial proportion of elderly patients even 30 days after treatment. Xenon-based anesthesia was not associated with decreased incidence of POCD in comparison to propofol.

[Anaesthetic considerations in endovascular repair of aortic aneurysms]. / Anästhesiologisches Management bei endovaskulärer Rekonstruktion.

With advancing developments of endovascular techniques, the demands on anaesthesiological management are increasing. The transfemoral implantation of coated endografts in the aorta of cardiopulmonal impaired patients is a particular challenge for the interdisciplinary team. Guided by invasive monitoring, changing blood-pressure targets have to be achieved and in case of serious complications conversion to open surgery must be available immediately.