medigraphic.com
ISSN 2078-7170 (Electronic)

2015, Number 1

<< Back Next >>

CorSalud 2015; 7 (1)

Postoperative neurological complications in patients undergoing cardiac surgery with cardiopulmonary bypass

Moré DA, Fuentes HL, Ceballos ÁA, Rodríguez GL, Plasencia PM, Zorrilla LY, Robaina CE, Zamora RO

Language: Spanish
References: 24
Page: 28-34
PDF size: 533.29 Kb.


ABSTRACT

Introduction: Neurological dysfunction in the postoperative period of cardiovascular surgery is one of the leading causes of disability, for the possible sequels after the onset of this complication.
Objective: To characterize the behavior of neurological complications in the post-operative period of patients undergoing cardiac surgery with cardiopulmonary bypass.
Method: A descriptive, longitudinal, retrospective study was conducted with 39 patients admitted to the surgical intensive care unit of the Cardiocentro Ernesto Che Guevara in Santa Clara, Cuba, who presented with neurological dysfunction in the immediate postoperative period, from January 2011 to December 2013.
Results: Neurological dysfunction was more frequent in males (74.3%) and the age group from 64 to 74 years. Myocardial revascularization was the most prevalent surgery. Smoking was present in 51.3% of patients and 92.3% suffered from hypertension. Most patients remained for more than 120 minutes with cardiopulmonary bypass. Type II neurological complications predominated, mainly disorientation in 35.9% of cases.
Conclusions: There was a predominance of males of advanced age, smokers, with hypertension, who underwent myocardial revascularization with prolonged cardiopulmonary bypass. Disorientation was the most common neurological complication.


REFERENCES

  1. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: A prospective, multicenter, randomized, double-blind, placebocontrolled pilot study. Crit Care Med. 2010;38:419- 27.

  2. Giakoumidakis K, Baltopoulos GI, Charitos C, Patelarou E, Galanis P, Brokalaki H. Risk factors for prolonged stay in cardiac surgery intensive care units. Nurs Crit Care. 2011;16:243-51.

  3. Gordon M. Complicaciones neurológicas en el postoperatorio de cirugía cardiovascular [Internet]. 5to. Congreso Virtual de Cardiología. Argentina; 2007. Disponible en: http://www.fac.org.ar/qcvc/llave/c051e/gordonm. php

  4. Liu YH, Wang DX, Li LH, Wu XM, Shan GJ, Su Y, et al. The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg. 2009;109:1013-22.

  5. Santos A, Pérez H, Valero A, Lage L, Borges YR. Factores preoperatorios relacionados con las complicaciones cardiovasculares de la cirugía de revascularización coronaria. Gac Med Espirituana [Internet]. 2010 [citado 6 Abr 2014]:12:[aprox. 11 p.]. Disponible en: http://bvs.sld.cu/revistas/gme/pub/vol.12.%283%2 9_06/p6.html

  6. Hogue CW, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: An evidence-based appraisal of current practices. Anesth Analg. 2006;103:21-37.

  7. McKhann GM, Grega MA, Borowicz LM, Bechamps M, Selnes OA, Baumgartner WA, et al. Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction. Arch Neurol. 2012;59:1422-8.

  8. Villalobos JA, García T, Reyna JL, Montes de Oca MA. Causas de delirium en adultos mayores post-operados de cirugía cardiaca. Rev Mex Cardiol. 2010;21:111-20.

  9. Zabala JA. Complicaciones neurológicas de la ciru-gía cardíaca. Rev Esp Cardiol. 2005;58:1003-6.

  10. Ribera A, Ferreira-González I, Cascant P, Marsal JR, Romero B, Pedrol D, et al. Supervivencia, estado clínico y calidad de vida a los cinco años de la ciru-gía coronaria. Estudio ARCA. Rev Esp Cardiol. 2009; 62:642-51.

  11. Tuman KJ, McCarthy RJ, Najafi H, Ivankovich AD. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg. 1992;104:1510-7.

  12. Pérez Vela J, Renes Carreño E, López Almodóvar L, Rubio Regidor M, Perales Rodríguez de Viguri N. Incidencia, perfil clínico y evolución de las compli-caciones neurológicas en el postoperatorio de ciru-gía cardiaca. Med Intensiva. 2003;27:284-5. [Resu-men].

  13. Smith MH, Wagenknecht LE, Legault C, Goff DC, Stump DA, Troost BT, et al. Age and other risk fac-tors for neuropsychologic decline in patients under-going coronary artery bypass graft surgery. J Car-diothorac Vasc Anesth. 2000;14:428-32.

  14. Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly pa-tients. N Engl J Med. 2013;368:1189-98.

  15. Balaguer JM, Lilly KJ, Connelly G, McAdams M, Philie P, Cohn LH, et al. Estrategia para minimizar complicaciones neurológicas durante cirugía de re-vascularización miocárdica con circulación extracor-pórea. Rev Argent Cir Cardiovasc [Internet]. 2003-2004 [citado 15 Abr 2014];1:[aprox. 23 p.]. Disponi-ble en: http://www.caccv.org.ar/raccvanterior/Vol01N02/complicacionesneurologicas.htm

  16. Lanas F, Avezum A, Bautista LE, Diaz R, Luna M, Is-lam S, et al. Risk factors for acute myocardial in-farction in Latin America: the INTERHEART Latin American study. Circulation. 2007;115:1067-74.

  17. Selnes OA, Gottesman RF, Grega MA, Baumgartner WA, Zeger SL, McKhann GM. Cognitive and neuro-logic outcomes after coronary-artery bypass sur-gery. N Engl J Med. 2012;366:250-7.

  18. Messerotti Benvenuti S, Zanatta P, Valfrè C, Polesel E, Palomba D. Preliminary evidence for reduced preoperative cerebral blood flow velocity as a risk factor for cognitive decline three months after car-diac surgery: an extension study. Perfusion. 2012; 27:486-92.

  19. Álvarez-Aliaga A, Rodríguez-Blanco LH, Quesada-Vázquez J, López C. Factores de riesgo de la enfer-medad cerebrovascular aguda hipertensiva. Rev Cubana Med [Internet]. 2006 [citado 29 Abr 2014]; 45:[aprox. 12 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232006000400006&lng=es&nrm=iso&tlng=es

  20. Newman MF, Mathew JP, Grocott HP, Mackensen GB, Monk T, Welsh-Bohmer KA, et al. Central ner-vous system injury associated with cardiac surgery. Lancet. 2006;368:694-703.

  21. Rubio-Regidor M, Pérez-Vela JL, Escribá-Bárcena A, Corres-Peiretti MA, Renes-Carreño E, Gutiérrez-Rodríguez J, et al. Complicaciones neurológicas en el postoperatorio de cirugía cardíaca. Med Inten-siva. 2007;31:241-50.

  22. Maimir Jané F. El péptido natriurético cerebral como factor pronóstico de complicaciones graves en el postoperatorio precoz de pacientes interve-nidos de cirugía cardíaca [Tesis]. Universidad Com-plutense de Madrid, Madrid; 2011. Disponible en: http://eprints.ucm.es/13769/1/T33216.pdf

  23. Suárez L, García de Loreanzo A, Suárez JR. Lesiones neurológicas durante la circulación extracorpórea: fisiopatología, monitorización y protección neuroló-gica. Med Intensiva. 2002;26:292-303.

  24. Hammon JW, Stump DA, Butterworth JF, Moody DM, Rorie K, Deal DD, et al. Coronary artery bypass grafting with single cross-clamp results in fewer persistent neuropsychological deficits than multiple clamp or off-pump coronary artery bypass grafting. Ann Thorac Surg. 2007;84:1174-8.




2020     |     www.medigraphic.com