AIRR - ANZCA Institutional Research Repository
Skip navigation
Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/532
Title: Cardiac surgery, the brain, and inflammation.
Authors: Scott, David A
Evered, Lisbeth A
Silbert, Brendan S
Issue Date: Mar-2014
Citation: The journal of extra-corporeal technology 2014-03; 46(1): 15-22
Abstract: Cognitive deterioration can reliably be measured after procedures requiring anesthesia and surgery. Cardiac surgery has had the spotlight because of the high reported incidence of postoperative cognitive dysfunction in early studies, but such effects occur after other surgical procedures as well. "Early" postoperative cognitive dysfunction should be considered as a different phenomenon, relating to acute pharmacological, physiological, and stress-related recovery. The focus should be on what is affecting patients at 3 months, 12 months, and 5 years later. Like with many other aspects of perioperative risk, a significant element is the patient's preoperative cognitive status. We now know that up to one-third of overtly "normal" elective cardiac surgical patients enter surgery with some degree of pre-existing cognitive impairment or, when applying psychogeriatric measures, mild cognitive impairment. The latter is a known prodrome or early stage of the amyloid associated Alzheimer's disease dementia. Inflammatory responses during cardiac surgery have been recognized for years, but our understanding of the complexity of systemic inflammatory response has grown significantly with the ability to assay neurohumoral markers such as interleukins. The blood-brain barrier is made vulnerable by both pre-existing disorders (mild cognitive impairment/amyloid; vascular disease) and by the inflammatory response to surgery and cardiopulmonary bypass. Inflammation affecting the brain at this time may set in motion accelerated neurological and hence cognitive decline that, despite an initial recovery and even functional improvement, may proceed to further long-term decline at an accelerated rate in susceptible individuals. Clinical data are emerging from longer-term studies to support this concern, but evidence for effective preventive or therapeutic strategies is limited.
URI: http://hdl.handle.net/11055/532
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/24779114
ISSN: 0022-1058
Journal Title: The journal of extra-corporeal technology
Type: Journal Article
Review
Appears in Collections:Scholarly and Clinical

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.