Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T13:51:55.607Z Has data issue: false hasContentIssue false

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
Get access

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

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

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

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×