Neurological monitoring as a safety system in patients undergoing cardiac surgery with cardiopulmonary bypass

Abstract

Objective: to evaluate the adequate cerebral perfusion in patients who underwent cardiac surgery with cardiopulmonary bypass. Methods: an observational, analytical, prospective and multicentric study was conducted. All adults patients scheduled for cardiac surgery with cardiopulmonary bypass were included, with hospital admission at least the day before the intervention, with a negative Pfeiffer test, without communication problems, and with informed consent. Cerebral monitoring with Masimo ROOT 03® was used with encephalogram measurement (4 channels), cerebral oximetry and anesthetic depth. As a pre and postoperative cognitive assessment instrument we used the Pfeiffer test. Results: 19 patients with a mean age of 64.8 ± 11.5 years were included. The postoperative Pfeiffer test showed no cognitive impairment in 78.9% of the cases. While the remaining 21.1% had mild cognitive impairment (1 patient had ischemic damage). In this group, all were valvular patients, older than 65 years of age, and had maximum glycemias greater than 180 mg/dL. In 75% of the patients with cognitive impairment, the baseline SrO2 was less than 57%, there was sustained hypotension at sometime during surgery and it had a decrease of more than 20% of its basal SrO2. Conclusions: Continuous brain monitoring (electroencephalogram, cerebral oxygen saturation, anesthetic depth, suppression rate) during cardiac surgery with cardiopulmonary bypass is a reliable, valid and necessary safety measure to improve the quality of perfusion and surgical patient care.