Article

Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6

Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Intensive Care Medicine (Impact Factor: 7.21). 12/2010; 36(12):2081-9. DOI: 10.1007/s00134-010-2004-4
Source: PubMed

ABSTRACT

It is difficult to substantiate the clinical diagnosis of postoperative delirium with objective parameters in intensive care units (ICU). The purpose of this study was to analyze (1) whether the bilateral bispectral (BIS) index, (2) cortisol as a stress marker, and (3) interleukin-6 as a marker of inflammation were different in delirious patients as compared to nondelirious ones after cardiac surgery.
On the first postoperative day, delirium was analyzed in 114 patients by using the confusion assessment method for ICU (CAM-ICU). Bilateral BIS data were determined; immediately thereafter plasma samples were drawn to analyze patients' blood characteristics. The current ICU medication, hemodynamic characteristics, SOFA and APACHE II scores, and artificial ventilation were noted.
Delirium was detected at 19.1 ± 4.8 h after the end of surgery in 32 of 114 patients (28%). Delirious patients were significantly older than nondelirious ones and were artificially ventilated 4.7-fold more often during the testing. In delirious patients, plasma cortisol and interleukin-6 levels were higher (p = 0.01). The mean BIS index was significantly lower in delirious patients (72.6 (69.6-89.1); median [interquartile range (IQR), 25th-75th percentiles] than in nondelirious patients, 84.8 (76.8-89.9). BIS EEG raw data analysis detected significant lower relative alpha and higher theta power. A significant correlation was found between plasma cortisol levels and BIS index.
Early postoperative delirium after cardiac surgery was characterized by increased stress levels and inflammatory reaction. BIS index measurements showed lower cortical activity in delirious patients with a low sensitivity (27%) and high specificity (96%).

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Available from: Juergen Kopitz, Sep 16, 2014
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    • "common complication after cardiac surgery with the approximate reported incidence of 20–80 % (Kilo et al. 2001). This complication is associated with increased mortality (Spiegel et al. 2011), longer hospital stay (Slater et al. 2009), increased hospital costs (Plaschke et al. 2010), reduced patient recovery (Slater et al. 2009), increased risk of dementia (Petersen et al. 2001), and long-period care (Bilotta et al. 2011). Cognitive dysfunction presume to be the result of physiological disturbances caused by the CPB (Farhoudi et al. 2010; Van Harten et al. 2012). "

    Full-text · Article · Jul 2015
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    • "common complication after cardiac surgery with the approximate reported incidence of 20–80 % (Kilo et al. 2001). This complication is associated with increased mortality (Spiegel et al. 2011), longer hospital stay (Slater et al. 2009), increased hospital costs (Plaschke et al. 2010), reduced patient recovery (Slater et al. 2009), increased risk of dementia (Petersen et al. 2001), and long-period care (Bilotta et al. 2011). Cognitive dysfunction presume to be the result of physiological disturbances caused by the CPB (Farhoudi et al. 2010; Van Harten et al. 2012). "
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    ABSTRACT: Coronary artery bypass graft (CABG) surgery is one of the most commonly performed invasive procedures worldwide [1, 2]. Since the introduction of cardiopulmonary bypass (CPB), the neurological consequence of CABG surgery has been an important subject [2]. Delirium is a major problem after CABG surgery with the approximate reported incidence rate of 20-80% [2]. This complication is associated with increased mortality, longer hospital stay, increased hospital costs, and long-term care [2-4]. Regarding the high incidence of delirium in patients undergoing CABG surgery, prophylactic treatment is preferable. Hence, pharmacological neuroprotective strategies have been developed for these patients [3, 4]. A meta-analysis indicated that preoperative low-dose and short-term administration of haloperidol or risperidone may modestly reduce delirium occurrence in high-risk patients that need intensive care unit (ICU) [4]. Other clinical trials have not reported any decreases in the incidence rate of delirium in patients receiving pharmacologic prophylactic (haloperidol, donepezil [5], citicoline [6], and rivastigmine) [7-9]. Acute inflammation and reduced serotonin neurotransmitter are the most important causes of delirium in these patients [10, 11]. In a meta-analysis, Peng et al. [12] showed the role of peripheral inflammatory markers, such as interleukin-6 and S-100 beta, in postoperative delirium [13]. Although some studies indicated that use of compounds with brain protective activities (such as propofol, aprotininand lidocaine) can prevent delirium after CABG surgery, no sufficient evidence was presented to make a change in standard clinical practice.
    Full-text · Article · Dec 2014 · Forschende Komplementärmedizin / Research in Complementary Medicine
    • "common complication after cardiac surgery with the approximate reported incidence of 20–80 % (Kilo et al. 2001). This complication is associated with increased mortality (Spiegel et al. 2011), longer hospital stay (Slater et al. 2009), increased hospital costs (Plaschke et al. 2010), reduced patient recovery (Slater et al. 2009), increased risk of dementia (Petersen et al. 2001), and long-period care (Bilotta et al. 2011). Cognitive dysfunction presume to be the result of physiological disturbances caused by the CPB (Farhoudi et al. 2010; Van Harten et al. 2012). "
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    ABSTRACT: We hypothesized that valerian root might prevent cognitive dysfunction in coronary artery bypass graft (CABG) surgery patients through stimulating serotonin receptors and anti-inflammatory activity. The aim of this study was to evaluate the effect of Valeriana officinalis root extract on prevention of early postoperative cognitive dysfunction after on-pump CABG surgery. In a randomized, double-blind, placebo-controlled trial, 61 patients, aged between 30 and 70 years, scheduled for elective CABG surgery using cardiopulmonary bypass (CPB), were recruited into the study. Patients were randomly divided into two groups who received either one valerian capsule containing 530 mg of valerian root extract (1,060 mg/daily) or placebo capsule each 12 h for 8 weeks, respectively. For all patients, cognitive brain function was evaluated before the surgery and at 10-day and 2-month follow-up by Mini Mental State Examination (MMSE) test. Mean MMSE score decreased from 27.03 +/- 2.02 in the preoperative period to 26.52 +/- 1.82 at the 10th day and then increased to 27.45 +/- 1.36 at the 60th day in the valerian group. Conversely, its variation was reduced significantly after 60 days in the placebo group, 27.37 +/- 1.87 at the baseline to 24 +/- 1.91 at the 10th day, and consequently slightly increased to 24.83 +/- 1.66 at the 60th day. Valerian prophylaxis reduced odds of cognitive dysfunction compared to placebo group (OR = 0.108, 95 % CI 0.022-0.545). We concluded that, based on this study, the cognitive state of patients in the valerian group was better than that in the placebo group after CABG; therefore, it seems that the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.
    No preview · Article · Aug 2014 · Psychopharmacology
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