Abstract
Postoperative cognitive dysfunction is a common complication following cardiac surgery. The incidence of cognitive dysfunction is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation. Clinical observations demonstrated that pulsatile flow was superior to nonpulsatile flow, and membrane oxygenator was superior to bubble oxygenator in terms of postoperative cognitive status. Nevertheless, cognitive assessments in patients receiving an on-pump and off-pump coronary artery bypass surgery have yielded inconsistent results. The exact mechanisms of postoperative cognitive dysfunction following coronary artery bypass grafting remain uncertain. The dual effects, neuroprotective and neurotoxic, of anesthetics should be thoroughly investigated. The diagnosis should be based on a comprehensive cognitive evaluation with neuropsychiatric tests, cerebral biomarker inspections, and electroencephalographic examination. The management strategies for cognitive dysfunction can be preventive or therapeutic. The preventive strategies of modifying surgical facilities and techniques can be effective for preventing the development of postoperative cognitive dysfunction. Investigational therapies may offer novel strategies of treatments. Anesthetic preconditioning might be helpful for the improvement of this dysfunction.
Highlights
Postoperative cognitive dysfunction (POCD), characterized by impairment of attention, concentration, and memory with possible long-term implications, is a frequent neurological sequela following cardiac surgery
The incidence of POCD depends on the types of operation, and it is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation[2]
A retrospective study demonstrated that coronary artery bypass grafting (CABG) is the most common cause of POCD after a cardiac operation with an incidence of 37.6% in 7 days and 20.8% in the 3rd month of the postoperative period[3]
Summary
Postoperative cognitive dysfunction (POCD), characterized by impairment of attention, concentration, and memory with possible long-term implications, is a frequent neurological sequela following cardiac surgery. POCD can be classified into two types: short-term and long-term The former is usually a transitory cognitive decline lasting up to 6 weeks after a cardiac operation with an incidence of 20–50%, whereas the latter can be a subtle deterioration of cognitive function occurring six months after an operation with an incidence of 10–30%[1]. A retrospective study demonstrated that coronary artery bypass grafting (CABG) is the most common cause of POCD after a cardiac operation with an incidence of 37.6% in 7 days and 20.8% in the 3rd month of the postoperative period[3]. Predictive risk factors of POCD may include old age, preexisting cerebral, cardiac, and vascular diseases, alcohol abuse, low educational level, and intra- and postoperative complications[7]. Increased lower frequencies, reduced complex activities, and incoherent cortical regions/fast rhythms shown on the electroencephalogram may indicate POCD[22]
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