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Perioperative EEG background and discharge abnormalities in children undergoing cardiac surgery: a prospective
Rouyi Lin1, Na Du2, Jinqing Feng1
1Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China; Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
Insights
Abnormal electroencephalogram (EEG) patterns are common in patients undergoing cardiac surgery for congenital heart disease and correlate with brain injury and adverse outcomes. Further research is needed to understand long-term neurodevelopmental effects.
Area of Science:
- Neuroscience
- Cardiology
- Pediatrics
Background:
- Congenital heart disease (CHD) often necessitates complex cardiac surgery.
- Perioperative neurological complications can significantly impact patient outcomes.
Purpose of the Study:
- To analyze electroencephalogram (EEG) abnormalities in patients with CHD before, during, and after cardiac surgery.
- To assess the relationship between EEG patterns, demographic/perioperative factors, and early patient outcomes.
Main Methods:
- Electroencephalogram (EEG) monitoring was performed preoperatively, intraoperatively, and postoperatively in 437 patients.
- EEG data included background activity and discharge abnormalities (seizures, spikes, delta brushes).
- Clinical data and postoperative brain MRI were collected to correlate with EEG findings.
Main Results:
- 49.3% of patients experienced intraoperative isoelectric EEG, linked to worse outcomes.
- Postoperative EEG abnormalities were frequent (49.9%), with many patients not recovering EEG background.
- EEG abnormalities correlated with brain injury on MRI and adverse clinical outcomes.
Conclusions:
- Perioperative EEG abnormalities are frequent in CHD patients undergoing cardiac surgery.
- These abnormalities are associated with demographic/perioperative factors and predict adverse early outcomes.
- Long-term neurodevelopmental outcomes related to EEG patterns require further investigation.
Background:
We analysed the characteristics of abnormal electroencephalogram (EEG) patterns before, during, and 48 h after cardiac surgery in patients with heterogeneous congenital heart disease to assess their relationship to demographic and perioperative variables and to early patient outcomes.
Methods:
In 437 patients enrolled in a single centre, EEG was evaluated for background (including sleep-wake cycle) and discharge (seizures, spikes/sharp waves, pathological delta brushes) abnormalities. Clinical data (arterial blood pressure, doses of inotropic drugs, and serum lactate concentrations) were recorded every 3 h. Postoperative brain MRI was performed before discharge.
Results:
Preoperative, intraoperative, and postoperative EEG was monitored in 139, 215, and 437 patients, respectively. Patients with a degree of preoperative background abnormalities (n=40) had more severe intraoperative and postoperative EEG abnormalities (P<0.0001). Intraoperatively, 106/215 (49.3%) patients progressed into an isoelectric EEG. Longer durations of isoelectric EEG were associated with more severe postoperative EEG abnormalities and brain injury on MRI (Ps≤0.003). Postoperative background abnormalities occurred in 218/437 (49.9%) patients, and 119 (54.6%) of them had not recovered after surgery. Seizures occurred in 36/437 (8.2%) patients, spikes/sharp waves in 359/437 (82.2%), and pathological delta brushes in 9/437 (2.0%). Postoperative EEG abnormalities correlated with degree of brain injury on MRI (Ps≤0.02). Demographic and perioperative variables were significantly correlated with postoperative EEG abnormalities, which in turn correlated with adverse clinical outcomes.
Conclusions:
Perioperative EEG abnormalities occurred frequently and correlated with numerous demographic and perioperative variables and adversely correlated with postoperative EEG abnormalities and early outcomes. The relation of EEG background and discharge abnormalities with long-term neurodevelopmental outcomes remains to be explored.
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