A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery:: II. neurologic and cognitive outcomes,☆☆,,★★,

Presented in part at the Fiftieth Annual Meeting of the Canadian Anaesthetists Society, Halifax, Nova Scotia, Canada, June 1993.
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Abstract

This double-blind, randomized comparison of pulsatile or nonpulsatile perfusion and alpha-stat or pH-stat management during cardiopulmonary bypass was designed to assess postoperative central nervous system outcomes. Methods : Neurologic and cognitive testing was conducted before the operation and 7 days and 2 months after the operation in 316 patients having coronary artery bypass and in a reference cohort of 40 patients having major vascular and thoracic operations. Results : As detailed in part I of this study, mortality in patients having coronary bypass was 2.8%. The incidence of stroke was 2.5% and did not differ among bypass groups. Mortality was 2.5% for the major surgery cohort. The incidence of cognitive ( p = 0.003) and either neurologic or cognitive dysfunction ( p = 0.0002) was higher at 7 days for the coronary bypass group than for the major surgery cohort. The incidence of neurologic dysfunction remained higher ( p = 0.050) at 2 months in the coronary bypass group. Cognitive dysfunction at 2 months was less prevalent after 90 minutes of cardiopulmonary bypass in patients managed with alpha-stat than with pH-stat strategy (27% versus 44%, p = 0.047). Conclusions : Postoperative central nervous system dysfunction is more prevalent in patients having coronary bypass than in those having major operations. Pulsatility has no effect on central nervous system outcomes, but alpha-stat management is associated with a decreased incidence of cognitive dysfunction in patients undergoing prolonged cardiopulmonary bypass. (J T HORAC C ARDIOVASC S URG 1995;110:349-62)

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From the Department of Anaesthesia, University Hospital, University of Western Ontario,a and Clinical Trials Resources Group, Robarts Research Institute,d London, Ontario; the Department of Psychology, Vancouver Hospital and Health Sciences Centre,b Vancouver, British Columbia; and the Department of Neurology, Civic Hospital,c University of Ottawa, Ottawa, Ontario, Canada.

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Supported by grant A1498 from the Heart and Stroke Foundation of Ontario.

Address for reprints: John M. Murkin, MD, Department of Anaesthesia, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5

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0022-5223/95 $3.00 + 0

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