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Intraoperative Cortical Asynchrony Predicts Abnormal Postoperative Electroencephalogram.

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Intraoperative electroencephalogram (EEG) cortical asynchrony in neonates undergoing cardiac surgery predicts abnormal postoperative EEGs. Increased asynchronous bursts during surgery indicate higher risk for seizures or prolonged asynchrony postoperatively.

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Area of Science:

  • Neuroscience
  • Pediatric Cardiology
  • Neurology

Background:

  • Postoperative electroencephalograms (EEGs) are crucial for detecting neurologic dysfunction in high-risk neonates after cardiac surgery.
  • Intraoperative EEG monitoring, though uncommon, can reveal cerebral changes during antegrade cerebral perfusion (ACP).
  • Variations in cerebral blood flow and temperature during ACP may manifest as cortical asynchrony on EEG.

Purpose of the Study:

  • To investigate if intraoperative EEG cortical asynchrony can identify neonates at risk for abnormal postoperative EEG findings.
  • To determine the association between intraoperative EEG patterns and postoperative neurologic outcomes in neonates undergoing cardiac surgery with ACP.

Main Methods:

  • Continuous hemodynamic and EEG monitoring was performed on neonates requiring ACP for cardiac procedures.
  • Cortical bursts (synchronous and asynchronous) were quantified during cooling, ACP, and rewarming phases.
  • Abnormal postoperative EEGs were defined as persistent asynchrony (>2 hours) or seizure activity.

Main Results:

  • Of 40 neonates, 8 (20%) exhibited abnormal postoperative EEGs (3 with seizures, 5 with persistent asynchrony).
  • Neonates with abnormal postoperative EEGs had a significantly higher total number of intraoperative asynchronous bursts (17 vs. 3; P < .001).
  • Intraoperative asynchronous bursts were independently associated with abnormal postoperative EEGs (OR, 1.35; P = .004).

Conclusions:

  • A higher number of intraoperative asynchronous cortical bursts is linked to abnormal postoperative EEG results in neonates undergoing cardiac surgery.
  • Intraoperative EEG monitoring can serve as a valuable tool for risk stratification in this patient population.
  • Cortical asynchrony during ACP may indicate underlying cerebral vulnerability.