Neurologic Dysfunction
Anyone with anesthesia is at risk for neurological dysfunction, and patients with cardio-pulmonary bypass surgery are at even higher risk. Neurological Dysfunction complications are more evident in the first 24-48 hours post-operatively.
Types of neurological dysfunction are:
cognitive dysfunction
Encephalopathy
Peripheral Nerve Injury
Stroke
Coma
Risk Factors are:
Hypertension
Diabetes mellitus
Carotid artery disease
Valve Surgery
Emergent surgery
Duration of the CPB (Coronary Pulmonary Bypass) time
Age >75
Low cardiac output
Atrial fibrillation
Re-sternotomy
Causes include:
Aortic cannulation, clamping and unclamping
Arteriosclerotic particicles, debris, platelets, fibrin, microbubbles, microemboli.
hypoperfusion
Infalmmation
Cerebral autoregulation dysfunction due to hypoxia, acid-base imbalance, hypothermia, diabetes or hypertension.
Prevention Pre-op:
Echocardiogram
CT of brain for patients with CVA/TIA within the last 3 months
Carotid artery assessment
Management of atrial fibrillation .
Prevention Intra-Op:
Inducing hypotermia for cerebro-protection
adequate oxygenation
Monitoring od hematocrit and blood pressure and PaCO2
Limiting CPB time or avoiding it all together.
maintaining a higher blood pressure for those patients with hypertension.
Prevention Post-Op:
Frequent and early neurological assessment to evaluate pupilarry reaction, response to voice, stimulus and pain, and spontaneous movement. (AKA whats your GCS Score?)
Agressively managing hypertension, hypoxia and atrial fibrillation.
Learn more from these resources