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Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients.

Ghaffary S, Hajhossein Talasaz A, Ghaeli P, Karimi A, Salehiomran A, Hajighasemi A, Bina P, Darabi S, Jalali A, Dianatkhah M, Noroozian M, Shahmansouri N - J Tehran Heart Cent (2015)

Bottom Line: In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model.Preoperative nitrate administration led to a significant improvement in POCD.It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient's life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.

Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.

Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.

Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients' basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus

Wechsler Memory Test (WMT) scores at base line, postoperative, and 3-month follow-up evaluations
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Figure 1: Wechsler Memory Test (WMT) scores at base line, postoperative, and 3-month follow-up evaluations

Mentions: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males. Among the 101 patients, 58 (57.4%) were available for the 3-month postoperative WMT follow-up. As is shown in Figure 1, although cognitive decline was evident in 65 (64.4%) patients at discharge, almost 100% of cognition function improved to baseline level after 3 months. Because of the importance of the postoperative WMT score in the prediction of long-term complications and numbers of patients on follow-up, the pre-and postoperative WMT scores and their change were analyzed in this study. All the univariate analyses are depicted in Tables 1 and 2. From the parameters included in the univariate analyses, the following showed significant effects on the postoperative WMT score (p value < 0.05): baseline WMT score; serum lactate dehydrogenase (LDH) level; serum level of T3; cross-clamp time; and preexistence of chronic obstructive pulmonary disease (Tables 1 and 2). In addition, among the preoperative medications, antiplatelet and statin administration exhibited a positive, albeit not statistically significant, effect on the postoperative WMT score (p value > 0.05).


Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients.

Ghaffary S, Hajhossein Talasaz A, Ghaeli P, Karimi A, Salehiomran A, Hajighasemi A, Bina P, Darabi S, Jalali A, Dianatkhah M, Noroozian M, Shahmansouri N - J Tehran Heart Cent (2015)

Wechsler Memory Test (WMT) scores at base line, postoperative, and 3-month follow-up evaluations
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477092&req=5

Figure 1: Wechsler Memory Test (WMT) scores at base line, postoperative, and 3-month follow-up evaluations
Mentions: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males. Among the 101 patients, 58 (57.4%) were available for the 3-month postoperative WMT follow-up. As is shown in Figure 1, although cognitive decline was evident in 65 (64.4%) patients at discharge, almost 100% of cognition function improved to baseline level after 3 months. Because of the importance of the postoperative WMT score in the prediction of long-term complications and numbers of patients on follow-up, the pre-and postoperative WMT scores and their change were analyzed in this study. All the univariate analyses are depicted in Tables 1 and 2. From the parameters included in the univariate analyses, the following showed significant effects on the postoperative WMT score (p value < 0.05): baseline WMT score; serum lactate dehydrogenase (LDH) level; serum level of T3; cross-clamp time; and preexistence of chronic obstructive pulmonary disease (Tables 1 and 2). In addition, among the preoperative medications, antiplatelet and statin administration exhibited a positive, albeit not statistically significant, effect on the postoperative WMT score (p value > 0.05).

Bottom Line: In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model.Preoperative nitrate administration led to a significant improvement in POCD.It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient's life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.

Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.

Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.

Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients' basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus