Neurological function Cardiac surgery questions

Question 1

What are 3 major causes of neurological dysfunction and injury during cardiac surgery

Answer 1

Microemboli

Hypoperfusion

Generalized inflammatory reaction

Majority of intra-operative strokes occur due to embolization of atherosclerotic material from the aorta and innominate vessels.

Alpha stat, phenylephine reduce injury.

Question 2

Risks for Type 1 neurological injury

Answer 2

Proximal aortic atherosclerosis
History of neurologic disease
Use of IABP
Diabetes
History of HTN
History of pulmonary disease
History of unstable angine
Age (per additional decade) 
*perioperative hypotension 
* ventricular venting

Question 3

Risks for type II cerebral dysfunction

Answer 3

History of pulmonary disease
Age
Systolic BP > 180 on admission
History of ETOH
Dyshythmia on day of surgery
antihypertensive theraoy
history of CABG
history of PAD

Question 4

Strategies for emboli protection during cardiac surgery

Answer 4

*possible cooling to 32 to 34 degree and a hematocrit to above 25C
Membrane oxygenator
adequate anticoagulation
closed-system CPB
washing of blood aspirated from surgical wound
filtering the arterial and venous outflow
control of all site of air entry into CPB
Removal of residual air from heart and great vessels
epiaortic ultrasound mapping of ascending aorta
minimal aortic manipulaation (single aortic crossclamp)
retrograde cardioplegia

Question 5

Is there a long term neuropsychological effect of CPB

Answer 5

Late follow-up studies that have included a control group have shown NO difference in outcomes between surgical and non surgical controls at 3 year, putting to rest the previous fear that surgical patients had recurrent neurocognitive deficits.

agressive medical therapy has a role.

Question 6

Classify cardiac surgery neurological injuries

Answer 6

Type 1: stroke with permanent fixed neurological deficit

Type 2: Coma or delerium