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Acute cerebral dysfunction after open-heart surgery. A reaction-time study.

P Elsass, L Henriksen

    Scandinavian Journal of Thoracic and Cardiovascular Surgery
    |January 1, 1984
    PubMed
    Summary
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    Continuous reaction time (CRT) tests revealed subtle central nervous system (CNS) dysfunction after open-heart surgery with extracorporeal circulation (ECC). Factors like ECC duration and low perfusion pressure correlated with delayed reaction times, indicating potential CNS damage.

    Area of Science:

    • Neurology
    • Cardiovascular Surgery
    • Anesthesiology

    Background:

    • Subtle central nervous system (CNS) dysfunction can occur after cardiac surgery.
    • Continuous reaction time (CRT) is a sensitive measure for detecting early CNS changes.

    Purpose of the Study:

    • To quantify the immediate effects of open-heart surgery and extracorporeal circulation (ECC) on CNS function using CRT.
    • To identify factors contributing to CNS dysfunction in patients undergoing ECC.

    Main Methods:

    • A continuous reaction time (CRT) test was administered to 19 patients undergoing open-heart surgery with ECC.
    • A control group of 17 patients underwent thoracic surgery without ECC.
    • Reaction times were analyzed in relation to anesthesia duration, ECC duration, perfusion pressure, and PCO2 levels.

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    Main Results:

    • Reaction time was significantly prolonged in both ECC and control groups post-surgery.
    • In the ECC group, prolonged CRT correlated with longer ECC duration, periods of low perfusion pressure (<50 mmHg), and higher PCO2 levels.
    • Acute reaction time changes resolved within a week, but 50% of ECC patients reported cognitive disturbances (memory impairment, mood lability) at two months.

    Conclusions:

    • Open-heart surgery with ECC can cause acute, reversible CNS dysfunction, indicated by prolonged reaction times.
    • ECC duration, low perfusion pressure, and PCO2 are significant factors in the pathogenesis of CNS dysfunction.
    • Long-term intellectual disturbances, including memory impairment and mood lability, are reported by a substantial portion of ECC patients post-recovery.