Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T23:58:24.405Z Has data issue: false hasContentIssue false
  • English
  • Français

Plasma concentrations of nitric oxide products and cognitive dysfunction following coronary artery bypass surgery

Published online by Cambridge University Press:  29 April 2005

D. Harmon ,
N. Eustace ,
K. Ghori ,
M. Butler ,
S. O'Callaghan ,
A. O'Donnell ,
G. M. Moore-Groarke  and
G. Shorten
D. Harmon
Affiliation:
Walton Centre for Neurology and Neurosurgery, Liverpool, UK
N. Eustace
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
K. Ghori
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
M. Butler
Affiliation:
Cork University Hospital, Department of Biochemistry, Cork, Ireland
S. O'Callaghan
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
A. O'Donnell
Affiliation:
Cork University Hospital, Department of Cardiothoracic Surgery, Cork, Ireland
G. M. Moore-Groarke
Affiliation:
Cork clinic, Department of Psychology, Cork, Ireland
G. Shorten
Affiliation:
Cork University Hospital and University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
Get access

Abstract

Summary

Background and objective: Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia–reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3−/NO2−) and cognitive dysfunction after CABG.

Methods: Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied.

Results: A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3−/NO2− concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3− plus NO2−) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups.

Conclusions: Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.

Keywords

CORONARY ARTERY BYPASS SURGERYMENTAL PROCESSES, cognitionHYPOXIA–ISCHAEMIA, brainBIOLOGICAL MARKERSREACTIVE NITROGEN SPECIES, nitric oxideNEUROPSYCHOLOGICAL TESTS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 4 , April 2005 , pp. 269 - 276
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Stump DA, Rogers AT, Hammon JW, Newman SP. Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothorac Vasc Anesth 1996; 10: 113–118.Google Scholar
Stockard JJ, Bickford RG, Schauble JF. Pressure-dependent cerebral ischemia during cardiopulmonary bypass. Neurology 1973; 23: 521–529.Google Scholar
Grigore AM, Grocott HP, Mathew JP, et al. The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg 2002; 94: 4–10.Google Scholar
Smith PLC. The systemic inflammatory response to cardiopulmonary bypass and the brain. Perfusion 1996; 11: 196–199.Google Scholar
Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary artery bypass surgery. New Engl J Med 1996; 335: 1857–1863.Google Scholar
Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary artery bypass surgery. New Engl J Med 2001; 344: 395–402.Google Scholar
Anderson RE, Hansson L, Liska J, Settergren G, Vaage J. The effect of cardiotomy suction on the brain injury marker S100β after cardiopulmonary bypass. Ann Thorac Surg 2000; 69: 847–850.Google Scholar
Wei G, Dawson VL, Zweier JL. Role of neuronal and endothelial nitric oxide synthase in nitric oxide generation in the brain following cerebral ischemia. Biochim Biophys Acta 1999; 1455: 23–34.Google Scholar
Endoh M, Maiese K, Wagner J. Expression of the inducible form of nitric oxide synthase by reactive astrocytes after transient global ischemia. Brain Res 1994; 651: 92–100.Google Scholar
Zhang ZG, Chopp M, Gautam S, et al. Upregulation of neuronal nitric oxide synthase and mRNA, and selective sparing of nitric oxide synthase-containing neurons after focal cerebral ischemia in rat. Brain Res 1994; 654: 85–95.Google Scholar
Iadecola C. Bright and dark sides of nitric oxide in ischemic brain injury. Trend Neurosci 1997; 20: 132–139.Google Scholar
Granger DL, Anstey NM, Miller WC, Weinberg JB. Measuring nitric oxide production in human clinical studies. Method Enzymol 1999; 301: 49–61.Google Scholar
Clark RS, Kochanek PM, Obrist WD, et al. Cerebrospinal fluid and plasma nitrite and nitrate concentrations after head injury in humans. Crit Care Med 1996; 24: 1243–1250.Google Scholar
Castillo J, Rama R, Dávalos A. Nitric-oxide-related brain damage in acute ischemic stroke. Stroke 2000; 31: 825–827.Google Scholar
Mykletun A, Stordal E, Dahl AA. Hospital anxiety and depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiat 2001; 179: 540–544.Google Scholar
Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg 1995; 59: 1289–1295.Google Scholar
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 2–9.Google Scholar
Smith PL, Treasure T, Newman SP, et al. Cerebral consequences of cardiopulmonary bypass. Lancet 1986; 1: 823–825.Google Scholar
Mathie RT, Ohri SK, Keogh BE, Williams J, Siney L, Griffith JM. Nitric oxide activity in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996; 5: 1394–1395.Google Scholar
Gohra H, Fujimura Y, Hamano K, et al. Nitric oxide release from coronary vasculature before, during and following cardioplegic arrest. World J Surg 1999; 23: 1249–1253.Google Scholar
Fujioka S, Mizumoto K, Okada K. A decreased serum concentration of nitrite/nitrate correlates with an increased plasma concentration of lactate during and after major surgery. Surg Today 2000; 30: 871–874.Google Scholar
Vingerhoets G, Van Nooten G, Jannes C. Neuropsychological impairment in candidates for cardiac surgery. J Int Neuropsych Soc 1997; 3: 480–485.Google Scholar
Ellis G, Adatia I, Yazdanpanah M, Makela S. Nitrite and nitrate analysis: a clinical biochemistry perspective. Clin Biochem 1998; 31: 195–220.Google Scholar
Liu B, Gao HM, Wang J, Jeohn GH, Cooper CL, Hong JS. Role of nitric oxide in inflammation-mediated neurodegeneration. Ann NY Acad Sci 2002; 962: 318–331.Google Scholar
Watanabe T, Akishita M, Toba K, et al. Influence of sex and age on serum nitrite/nitrate concentration in healthy subjects. Clin Chim Acta 2000; 301: 169–179.Google Scholar
Reckelhoff JF, Kellum JA, Blanchard EJ, et al. Changes in nitric oxide precursor, l-arginine, and metabolites, nitrate and nitrite, with aging. Life Sci 1994; 55: 1895–1902.Google Scholar
Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol 2003; 17: 259–272.Google Scholar
Myles PS, Leong CK, Currey J. Endogenous nitric oxide and low systemic vascular resistance after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11: 571–574.Google Scholar
Matata BM, Galinanes M. Effect of diabetes on nitric oxide metabolism during cardiac surgery. Diabetes 2001; 50: 2603–2610.Google Scholar
Bruggemans EF, Van de Vijver F, Huysmans HA. Assessment of cognitive deterioration in individual patients following cardiac surgery: correction for measurement error and practice effects. J Clin Exper Neuropsychol 1997; 19: 543–559.Google Scholar