Neuropsychological complications after cardiac surgery in children

David C Bellinger
2000 Critical Care  
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption.
more » ... Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1]. Critical Care Vol 4 Suppl B Abstracts of the 2 nd International Symposium on the Pathophysiology of Cardiopulmonary Bypass References 1. Young WL, Ornstein E: Cerebral and spinal cord blood flow. In: Anesthesia and Neurosurgery. Edited by Cottrell JE, Smith DS. St. Louis, MO: Mosby, 1994:17-58. 2. Murkin JM, Farrar JK, Tweed WA, et al: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO 2 . Anesth Analg 1987, 66:825-832. 3. Hindman BJ, Funatsu N, Harrington J, et al: Cerebral blood flow response to PaCO 2 during hypothermic cardiopulmonary bypass in rabbits. Anesthesiology 1991, 75:662-668. 4. Paulson OB, Strandgaard S, Edvinsson L: Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990, 2:161-192. 5. Hindman BJ, Dexter F, Ryu KH, et al: Pulsatile versus nonpulsatile cardiopulmonary bypass. No difference in brain blood flow or metabolism at 27 degrees C. Anesthesiology 1994, 80:1137-1147. 6. Rogers AT, Prough DS, Roy RC, et al: Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 1992, 103:363-368. 7. Todd MM, Weeks JB, Warner DS: Cerebral blood flow, blood volume, and brain tissue hematocrit during isovolemic hemodilution with hetastarch in rats. Conclusion: Corticosteroids, even at moderate doses, are able to reduce the amount of NSE liberation during CPB. This may indicate less brain injury during CPB. Whether this reduction in NSE liberation translates into improved neurological outcome remains to be studied.
doi:10.1186/cc673 fatcat:l2t3rbmjjbhk5bj5v2xfnvajtu