Original Articles
Neuropsychologic testing within 18 hours after cardiac surgery*,**

https://doi.org/10.1053/jcan.2001.20212Get rights and content

Abstract

Objective: To undertake neuropsychologic testing within 18 hours of cardiac surgery after fast-track anesthesia. Design: Prospective study. Setting: University hospital, single center. Participants: Fifty patients undergoing first-time elective coronary artery surgery. Interventions: A neuropsychologic test battery was administered preoperatively and 18 hours and 5 days after surgery. Main Results: Seven patients were withdrawn, and 9 patients did not attempt the postoperative tests (on both occasions) because of medical complications. Thirty patients completed ≥4 tests at both postoperative occasions. Of these, 9 patients (30%) showed a deficit in ≥2 tests at 18 hours postoperatively, and 3 (10%) showed a deficit at 5 days postoperatively. Conclusion: In the absence of medical complications and despite the difficulties, early postoperative neuropsychologic testing is possible after fast-track anesthesia. Such testing has the potential to more clearly define the course of cognitive decline after cardiac surgery. Copyright © 2001 by W.B. Saunders Company

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Methods

This study was approved by the Human Research Ethics Committee at this institution, and informed consent was obtained from all patients. Fifty patients scheduled for elective first-time coronary artery surgery were enrolled in the preadmission clinic. Patients were excluded if there was pre-existing neurologic or neurovascular disease (eg, stroke), if there was anticipated difficulty with completion of neuropsychologic function assessments, or if English was not the primary language. Patients

Results

Fifty patients were enrolled in the study. The average age was 66 ± 8 (SD) years, and there were 39 men and 11 women. Operative and postoperative data are shown in Tables 1 and 2.

. Operative Data

Empty CellPatients (Value = 50)
Number of Patients50
Duration of surgery (min)241 ± 46
Cardiopulmonary bypass time (min)99 ± 26
Cross-clamp time (min)79 ± 23
Minimum temperature (°C)31.9 ± 1.1
Grafts placed (No.)3.5 (2-6)

NOTE. All values are expressed as mean ± SD except graft number, which is mean and range.

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Discussion

Despite the practical difficulties, the authors believe there are good reasons to obtain neuropsychologic results early after surgery. First, it is hypothesized that because there is a tendency for deficits to improve with time, some deficits may be detected that are no longer present when testing is undertaken 3 to 5 days postoperatively. If this hypothesis were true, early testing would be a more accurate endpoint in assessing causative factors of intraoperative cerebral insults; to date,

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*

Supported in part by the Australian and New Zealand College of Anaesthetists.

**

Address reprint requests to Brendan S. Silbert, MB, BS, FANZCA, Department of Anaesthesia, St Vincent's Hospital, Victoria Parade, Melbourne, Australia 3065.

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