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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/639
Title: Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?
Authors: Mitchell, SJ
Merry, AF
ANZCA/FPM Author: Merry, AF
Mitchell, SJ
Keywords: cardiopulmonary bypass
CPB
embolism
cerebral complications
cerebral protection
gaseous microemboli
Issue Date: 2015
Citation: 47(1):10–15
Abstract: From the time an association was perceived between cardiac surgery and post-operative cognitive dysfunction (POCD), there has been interest in arterial microemboli as one explanation. A succession of studies in the mid-1990s reported a correlation between microemboli exposure and POCD and there followed a focus on microemboli reduction (along with other strategies) in pursuit of peri-operative neuroprotection. There is some evidence that the initiatives developed during this period were successful in reducing neurologic morbidity in cardiac surgery. More recently, however, there is increasing awareness of similar rates of POCD following on and off pump cardiac operations, and following many other types of surgery in elderly patients. This has led some to suggest that cardiopulmonary bypass (CPB) and microemboli exposure by implication are non-contributory. Although the risk factors for POCD may be more patient-centered and multifactorial than previously appreciated, it would be unwise to assume that CPB and exposure to microemboli are unimportant. Improvements in CPB safety (including emboli reduction) achieved over the last 20 years may be partly responsible for difficulty demonstrating higher rates of POCD after cardiac surgery involving CPB in contemporary comparisons with other operations. Moreover, microemboli (including bubbles) have been proven harmful in experimental and clinical situations uncontaminated by other confounding factors. It remains important to continue to minimize patient exposure to microemboli as far as is practicable.
URI: http://hdl.handle.net/11055/639
PubMed URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566815/
Journal Title: The Journal of Extra-corporeal Technology
Type: Journal Article
Affiliates: Department of Anaesthesiology, School of Medicine, University of Auckland
Department of Anaesthesia, Auckland City Hospital
Study/Trial: Case Control Studies
Appears in Collections:Scholarly and Clinical

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