Postoperative delirium and cognitive decline following heart surgery are valid concerns among patients and physicians alike. Efforts to reduce postoperative neurocognitive complications, which include preoperative screening for risk factors and leveraging optimal anesthetic techniques, may reduce postoperative mortality, shorten hospital stays, and decrease the need for long-term care.

Examining the issues and remedies is the focus of Friday’s session “Brain Recovery After Cardiac Surgery: Reducing Postoperative Delirium and Cognitive Dysfunction.” Andra Ibrahim Duncan, MD, MS, Associate Professor of Anesthesiology at the Cleveland Clinic in Ohio, will moderate the session that explores the risks associated with the invasive nature of cardiac surgery.

“The high-risk nature of cardiac surgery, which often includes perioperative hemodynamic instability and complications related to cardiopulmonary bypass, contributes to a higher rate of postoperative neurocognitive disorders than other less invasive procedures,” Dr. Duncan said. “The brain is sensitive to hypotension, low cardiac output, inflammation and thromboembolic events—all of these can occur during the perioperative period and result in adverse effects on brain function.”

Recognizing patient risk factors, including the patient’s baseline cognitive function, understanding brain and heart physiology, and meticulous anesthesia and surgical planning are essential first steps in the preoperative phase, she said.

Risk factors include advanced age, serious, underlying co-morbidities, poor heart function, poor baseline cognitive and functional status, and previous cardiac surgery. After cardiac surgery, physicians should look for neurocognitive complications, such as confusion, disorientation, loss of short-term or long-term memory, and impaired judgment.

“Anesthesiologists should rule out other serious neurologic disease which may explain any postoperative neurocognitive abnormalities. Signs of infection should be investigated and current medications should be examined to ensure that they are not contributing to neurocognitive disorders,” Dr. Duncan said. “It’s important to provide supportive treatment therapy, including optimal blood pressure management, respiratory support, and treatment of acid-base and electrolyte abnormalities.”

As for specific techniques, Dr. Duncan said anesthesia management includes maintaining hemodynamic stability, providing adequate oxygenation and ventilation, maintaining normal electrolyte and blood glucose levels, and ensuring adequate pain control.

While it’s well documented that cardiac surgery can have adverse postoperative effects on neurocognitive function, Dr. Duncan said anesthesiologists must appreciate the risk associated with the patient’s preoperative condition, provide optimal anesthesia management, and continue to follow the latest research discoveries that will improve patient outcomes.

“Efforts to reduce the risk for these neurocognitive disorders are among our chief priorities as well as dedicating more research into identifying effective therapies,” she said.

Return to Index

• 
• 
• 
•