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.
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