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Chapter 18 - Neuromonitoring and Cerebral Morbidity Associated with Cardiopulmonary Bypass

Published online by Cambridge University Press:  24 October 2022

By
Etienne J Couture ,
Stéphanie Jarry  and
André Y Denault
Edited by
Florian Falter ,
Albert C. Perrino, Jr  and
Robert A. Baker
Florian Falter
Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr
Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker
Affiliation:
Flinders Medical Centre, Adelaide
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Summary

Neurological complications after a cardiac surgery are common and have a large impact on patient outcomes. They are the result of a combination of numerous factors, many of them associated with cardiopulmonary bypass (CPB). Blood pressure control is essential to reduce the incidence of cerebral hypoperfusion and ischemic stroke during and after cardiac surgery. Cerebral oxygen saturation can be tracked using near infrared spectroscopy to assess cerebral perfusion and oxygenation. Careful temperature management plays a key role in preventing cerebral morbidity. Despite multiple attempts to find pharmacologic strategies to prevent neurologic injury, no such solution has been found to reduce the burden of neurologic complications associated with cardiac surgery.

Keywords

Risk Factors for Neurological InjuryBlood Pressure ControlCerebral Oxygen SaturationPharmacologic Optins for NeuroprotectionTemperature ManagementEipaortic Ultrasound
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 175 - 183
Publisher: Cambridge University Press
Print publication year: 2022

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References

Suggested Further Reading

Liu, Y, Chen, K, Mei, W. Neurological complications after cardiac surgery: anesthetic considerations based on outcome evidence. Curr Opin Anaesthesiol 2019; 32: 563–567.CrossRefGoogle ScholarPubMed
Joshi, B, Ono, M, Brown, C et al. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg 2012; 114: 503–510.CrossRefGoogle ScholarPubMed
Sun, X, Lindsay, J, Monsein, LH et al. Silent brain injury after cardiac surgery: a review: cognitive dysfunction and magnetic resonance imaging diffusion-weighted imaging findings. J Am Coll Cardiol 2012; 60: 791–797.Google Scholar
Vedel, AG, Holmgaard, F, Rasmussen, LS et al. High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: a randomized controlled trial. Circulation 2018; 137: 1770–1780.CrossRefGoogle ScholarPubMed
Hogue, CW, Brown, CH 4th, Hori, D et al. Personalized blood pressure management during cardiac surgery with cerebral autoregulation monitoring: a randomized trial. Semin Thorac Cardiovasc Surg 2021; 33: 429–438.CrossRefGoogle ScholarPubMed
Lewis, C, Parulkar, SD, Bebawy, J et al. Cerebral neuromonitoring during cardiac surgery: a critical appraisal with an emphasis on near-infrared spectroscopy. J Cardiothorac Vasc Anesth 2018; 32: 2313–2322.Google Scholar
Biancari, F, Santini, F, Tauriainen, T et al. Epiaortic ultrasound to prevent stroke in coronary artery bypass grafting. Ann Thorac Surg. 2020 January;109(1): 294–301.Google Scholar
Chen, F, Duan, G, Wu, Z et al. Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis. BMJ Open 2017; 7: e014629.Google Scholar
Hudetz, JA, Patterson, KM, Iqbal, Z et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2009; 23: 651–657.CrossRefGoogle ScholarPubMed
Engelman, R, Baker, RA, Likosky, DS et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical practice guidelines for cardiopulmonary bypass – temperature management during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2015; 29: 1104–1113.CrossRefGoogle Scholar

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