Central Nervous System Care in Postoperative Adult Cardiac Surgery

  • Ali DabbaghEmail author


CNS dysfunction after cardiac surgery is considered among the most important etiologies for morbidities and mortalities after cardiac surgery and patients undergoing cardiac surgery might be affected by unwanted CNS complications; this is a well-established finding in many studies.

Although postoperative period-related factors constitute only about one-fifth (20%) of etiologies of postoperative CNS complications of cardiac surgery, the CNS complications are not usually seen intraoperatively; those CNS complications seen first during the hospitalization period are usually encountered in ICU.

Two main classifications are used for categorizing postoperative CNS injuries in cardiac surgery patients. The first is mainly a clinical classification (including type I and type II disorders), while the second is a time-based classification (including early and late diseases).

Advanced age, high preoperative creatinine level, prior neurological event, prolonged cardiopulmonary bypass time, and female gender are considered as early risk factors, while prior neurologic event, diabetes mellitus, unstable angina, previous cerebral vascular disease, need for inotropic support, and postoperative atrial fibrillation are considered as delayed risk factors. Aortic atherosclerosis is considered as both an acute and a chronic risk factor. The underlying mechanisms are classified into five main classes: patient-related etiologies, intraoperative surgical etiologies, intraoperative anesthetic etiologies, intraoperative extracorporeal circulation (ECC) etiologies, and postoperative period-related etiologies; a number of potential etiologies have been proposed in each class. Prevention strategies include pharmacologic neuroprotection and CPB-related techniques. Novel and older technologies are used to improve the CNS outcome.


Classification and mechanisms of CNS dysfunction after cardiac surgery General considerations of CNS dysfunction after cardiac surgery Classification of CNS injuries Type I and type II injuries Time-based classification of postoperative CNS injuries Risk factors of CNS injuries Mechanisms and potential etiologies of CNS injuries Prevention strategies Pharmacologic neuroprotection CPB-related equipment Neurologic monitoring 


  1. Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, Pierini V, Dessi Fulgheri P, Lattanzio F, O’Mahony D, Cherubini A. Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP Series. PLoS One. 2015;10:e0123090.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, Cherubini A, Jones C, Kehlet H, MacLullich A, Radtke F, Riese F, Slooter AJ, Veyckemans F, Kramer S, Neuner B, Weiss B, Spies CD. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017;34:192–214.CrossRefPubMedGoogle Scholar
  3. Bannon L, McGaughey J, Clarke M, McAuley DF, Blackwood B. Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research. Syst Rev. 2016;5:75.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.CrossRefPubMedGoogle Scholar
  5. Bartels K, McDonagh DL, Newman MF, Mathew JP. Neurocognitive outcomes after cardiac surgery. Curr Opin Anaesthesiol. 2013;26:91–7.CrossRefPubMedGoogle Scholar
  6. Benggon M, Chen H, Applegate R, Martin R, Zhang JH. Effect of dexmedetomidine on brain edema and neurological outcomes in surgical brain injury in rats. Anesth Analg. 2012;115:154–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Biancari F, Tauriainen T, Perrotti A, Dalen M, Faggian G, Franzese I, Chocron S, Ruggieri VG, Bounader K, Gulbins H, Reichart D, Svenarud P, Santarpino G, Fischlein T, Puski T, Maselli D, Dominici C, Nardella S, Mariscalco G, Gherli R, Musumeci F, Rubino AS, Mignosa C, De Feo M, Bancone C, Gatti G, Maschietto L, Santini F, Salsano A, Nicolini F, Gherli T, Zanobini M, Saccocci M, D’Errigo P, Kinnunen EM, Onorati F. Bleeding, transfusion and the risk of stroke after coronary surgery: a prospective cohort study of 2357 patients. Int J Surg. 2016;32:50–7.CrossRefPubMedGoogle Scholar
  8. Brascia D, Garcia-Medina N, Kinnunen EM, Tauriainen T, Airaksinen J, Biancari F. Impact of transfusion on stroke after cardiovascular interventions: meta-analysis of comparative studies. J Crit Care. 2017a;38:157–63.CrossRefPubMedGoogle Scholar
  9. Brascia D, Reichart D, Onorati F, Perrotti A, Ruggieri VG, Bounader K, Verhoye JP, Santarpino G, Fischlein T, Maselli D, Dominici C, Mariscalco G, Gherli R, Rubino AS, De Feo M, Bancone C, Gatti G, Santini F, Dalen M, Saccocci M, Faggian G, Tauriainen T, Kinnunen EM, Nicolini F, Gherli T, Rosato S, Biancari F. Validation of bleeding classifications in coronary artery bypass grafting. Am J Cardiol. 2017b;119:727–33.CrossRefPubMedGoogle Scholar
  10. Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics. 2002;43:183–94.CrossRefPubMedGoogle Scholar
  11. Bruggemans EF. Cognitive dysfunction after cardiac surgery: pathophysiological mechanisms and preventive strategies. Neth Heart J. 2013;21:70–3.CrossRefPubMedGoogle Scholar
  12. Bruno JJ, Warren ML. Intensive care unit delirium. Crit Care Nurs Clin North Am. 2010;22:161–78.CrossRefPubMedGoogle Scholar
  13. Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg. 2004;127:57–64.CrossRefPubMedGoogle Scholar
  14. Bush SH, Marchington KL, Agar M, Davis DH, Sikora L, Tsang TW. Quality of clinical practice guidelines in delirium: a systematic appraisal. BMJ Open. 2017a;7:e013809.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Bush SH, Tierney S, Lawlor PG. Clinical assessment and management of delirium in the palliative care setting. Drugs. 2017b;77(15):1623–43.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Carrascal Y, Casquero E, Gualis J, Di Stefano S, Florez S, Fulquet E, Echevarria JR, Fiz L. Cognitive decline after cardiac surgery: proposal for easy measurement with a new test. Interact Cardiovasc Thorac Surg. 2005;4:216–21.CrossRefPubMedGoogle Scholar
  17. Coburn M, Fahlenkamp A, Zoremba N, Schaelte G. Postoperative cognitive dysfunction: incidence and prophylaxis. Anaesthesist. 2010;59:177–84; quiz 185CrossRefPubMedGoogle Scholar
  18. Dabbagh A. Postoperative CNS care. In: Dabbagh A, Esmailian F, Aranki S, editors. Postoperative critical care for cardiac surgical patients. 1st ed. New York: Springer; 2014a. p. 245–56.CrossRefGoogle Scholar
  19. Dabbagh A. Postoperative central nervous system monitoring. In: Dabbagh A, Esmailian F, Aranki S, editors. Postoperative critical care for cardiac surgical patients. 1st ed. New York: Springer; 2014b. p. 129–59.CrossRefGoogle Scholar
  20. Dabbagh A, Rajaei S. Xenon: a solution for anesthesia in liver disease? Hepat Mon. 2012;12:e8437.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Dabbagh A, Ramsay MAE. Postoperative central nervous system management in patients with congenital heart disease. In: Dabbagh A, Conte AH, Lubin L, editors. Congenital heart disease in pediatric and adult patients: anesthetic and perioperative management. 1st ed. New York: Springer; 2017a. p. 829–50.CrossRefGoogle Scholar
  22. Dabbagh A, Ramsay MAE. Central nervous system monitoring in pediatric cardiac surgery. In: Dabbagh A, Conte AH, Lubin L, editors. Congenital heart disease in pediatric and adult patients: anesthetic and perioperative management. 1st ed. New York: Springer; 2017b. p. 279–316.CrossRefGoogle Scholar
  23. Dabbagh A, Talebi Z, Rajaei S. Cardiovascular pharmacology in pediatric patients with congenital heart disease. In: Dabbagh A, Conte AH, Lubin L, editors. Congenital heart disease in pediatric and adult patients: anesthetic and perioperative management. 1st ed. New York: Springer; 2017. p. 117–95.CrossRefGoogle Scholar
  24. Dvir D, Genereux P, Barbash IM, Kodali S, Ben-Dor I, Williams M, Torguson R, Kirtane AJ, Minha S, Badr S, Pendyala LK, Loh JP, Okubagzi PG, Fields JN, Xu K, Chen F, Hahn RT, Satler LF, Smith C, Pichard AD, Leon MB, Waksman R. Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes. Eur Heart J. 2014;35:2663–71.CrossRefPubMedGoogle Scholar
  25. El Hussein M, Hirst S, Salyers V. Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon. J Clin Nurs. 2015;24:906–15.CrossRefPubMedGoogle Scholar
  26. Fahy BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Crit Care Med. 2009;37:1769–76.CrossRefPubMedGoogle Scholar
  27. Fink HA, Hemmy LS, MacDonald R, Carlyle MH, Olson CM, Dysken MW, McCarten JR, Kane RL, Garcia SA, Rutks IR, Ouellette J, Wilt TJ. Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review. Ann Intern Med. 2015;163:107–17.CrossRefPubMedGoogle Scholar
  28. Flaherty MP, Mohsen A, Moore JB, Bartoli CR, Schneibel E, Rawasia W, Williams ML, Grubb KJ, Hirsch GA. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2015;85:118–29.CrossRefPubMedGoogle Scholar
  29. Fok MC, Sepehry AA, Frisch L, Sztramko R, Borger van der Burg BL, Vochteloo AJ, Chan P. Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry. 2015;30:333–44.CrossRefPubMedGoogle Scholar
  30. Funder KS, Steinmetz J, Rasmussen LS. Cognitive dysfunction after cardiovascular surgery. Minerva Anestesiol. 2009;75:329–32.PubMedGoogle Scholar
  31. Grigore AM, Murray CF, Ramakrishna H, Djaiani G. A core review of temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter? Anesth Analg. 2009;109:1741–51.CrossRefPubMedGoogle Scholar
  32. Grocott HP. PRO: temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter? Anesth Analg. 2009;109:1738–40.CrossRefPubMedGoogle Scholar
  33. Heckman GA, Patterson CJ, Demers C, St Onge J, Turpie ID, McKelvie RS. Heart failure and cognitive impairment: challenges and opportunities. Clin Interv Aging. 2007;2:209–18.PubMedPubMedCentralGoogle Scholar
  34. Hedberg M, Boivie P, Engstrom KG. Early and delayed stroke after coronary surgery—an analysis of risk factors and the impact on short- and long-term survival. Eur J Cardiothorac Surg. 2011;40:379–87.PubMedGoogle Scholar
  35. Hedberg M, Engstrom KG. Stroke after cardiac surgery—hemispheric distribution and survival. Scand Cardiovasc J. 2012;47(3):136–44.CrossRefPubMedGoogle Scholar
  36. Hogue CW, Fucetola R, Hershey T, Freedland K, Davila-Roman VG, Goate AM, Thompson RE. Risk factors for neurocognitive dysfunction after cardiac surgery in postmenopausal women. Ann Thorac Surg. 2008a;86:511–6.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Hogue CW, Gottesman RF, Stearns J. Mechanisms of cerebral injury from cardiac surgery. Crit Care Clin. 2008b;24:83–98, viii–ix.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Hogue CW Jr, Freedland K, Hershey T, Fucetola R, Nassief A, Barzilai B, Thomas B, Birge S, Dixon D, Schechtman KB, Davila-Roman VG. Neurocognitive outcomes are not improved by 17beta-estradiol in postmenopausal women undergoing cardiac surgery. Stroke. 2007;38:2048–54.CrossRefPubMedGoogle Scholar
  39. Hogue CW Jr, Fucetola R, Hershey T, Nassief A, Birge S, Davila-Roman VG, Barzilai B, Thomas B, Schechtman KB, Freedland K. The role of postoperative neurocognitive dysfunction on quality of life for postmenopausal women 6 months after cardiac surgery. Anesth Analg. 2008;107:21–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Hogue CW Jr, Murphy SF, Schechtman KB, Davila-Roman VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–7.CrossRefPubMedGoogle Scholar
  41. Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliat Med. 2013;27:486–98.CrossRefPubMedGoogle Scholar
  42. Hu RF, Jiang XY, Chen J, Zeng Z, Chen XY, Li Y, Huining X, Evans DJ. Non-pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database Syst Rev. 2015;10:Cd008808.Google Scholar
  43. Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: the hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry. 2014;1:312–5.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Karhausen JA, Smeltz AM, Akushevich I, Cooter M, Podgoreanu MV, Stafford-Smith M, Martinelli SM, Fontes ML, Kertai MD. Platelet counts and postoperative stroke after coronary artery bypass grafting surgery. Anesth Analg. 2017;125:1129–39.CrossRefPubMedGoogle Scholar
  45. Karkouti K, Djaiani G, Borger MA, Beattie WS, Fedorko L, Wijeysundera D, Ivanov J, Karski J. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery. Ann Thorac Surg. 2005;80:1381–7.CrossRefPubMedGoogle Scholar
  46. Kinnunen EM, De Feo M, Reichart D, Tauriainen T, Gatti G, Onorati F, Maschietto L, Bancone C, Fiorentino F, Chocron S, Bounader K, Dalen M, Svenarud P, Faggian G, Franzese I, Santarpino G, Fischlein T, Maselli D, Dominici C, Nardella S, Gherli R, Musumeci F, Rubino AS, Mignosa C, Mariscalco G, Serraino FG, Santini F, Salsano A, Nicolini F, Gherli T, Zanobini M, Saccocci M, Ruggieri VG, Philippe Verhoye J, Perrotti A, Biancari F. Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients. Transfusion. 2017;57:178–86.CrossRefPubMedGoogle Scholar
  47. Knauert MP, Haspel JA, Pisani MA. Sleep loss and circadian rhythm disruption in the intensive care unit. Clin Chest Med. 2015;36:419–29.CrossRefPubMedGoogle Scholar
  48. Knipp SC, Kahlert P, Jokisch D, Schlamann M, Wendt D, Weimar C, Jakob H, Thielmann M. Cognitive function after transapical aortic valve implantation: a single-centre study with 3-month follow-up. Interact Cardiovasc Thorac Surg. 2013;16:116–22.CrossRefPubMedGoogle Scholar
  49. Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, Bridges CR, Haan CK, Svedjeholm R, Taegtmeyer H, Shemin RJ. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009;87:663–9.CrossRefPubMedGoogle Scholar
  50. Liu YH, Wang DX, Li LH, Wu XM, Shan GJ, Su Y, Li J, Yu QJ, Shi CX, Huang YN, Sun W. The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg. 2009;109:1013–22.CrossRefPubMedGoogle Scholar
  51. Lombard FW, Mathew JP. Neurocognitive dysfunction following cardiac surgery. Semin Cardiothorac Vasc Anesth. 2010;14:102–10.CrossRefPubMedGoogle Scholar
  52. Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ, Ewing BA, Motala A, Perry T. AHRQ comparative effectiveness reviews. In:Off-label use of atypical antipsychotics: an update. Rockville, MD: Agency for Healthcare Research and Quality (US); 2011.Google Scholar
  53. Marasco SF, Sharwood LN, Abramson MJ. No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis. Eur J Cardiothorac Surg. 2008;33:961–70.CrossRefPubMedGoogle Scholar
  54. Martinez F, Tobar C, Hill N. Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age Ageing. 2015;44:196–204.CrossRefPubMedGoogle Scholar
  55. Mashour GA, Avitsian R, Lauer KK, Soriano SG, Sharma D, Koht A, Crosby G. Neuroanesthesiology Fellowship Training: curricular guidelines from the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol. 2013;25:1–7.CrossRefPubMedGoogle Scholar
  56. Mathew JP, Mackensen GB, Phillips-Bute B, Grocott HP, Glower DD, Laskowitz DT, Blumenthal JA, Newman MF. Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke. 2009;40:880–7.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, Kales HC. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72:438–45.CrossRefPubMedPubMedCentralGoogle Scholar
  58. McKhann GM, Grega MA, Borowicz LM Jr, Bailey MM, Barry SJ, Zeger SL, Baumgartner WA, Selnes OA. Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. Neurology. 2005;65:991–9.CrossRefPubMedGoogle Scholar
  59. McKhann GM, Grega MA, Borowicz LM Jr, Baumgartner WA, Selnes OA. Stroke and encephalopathy after cardiac surgery: an update. Stroke. 2006;37:562–71.CrossRefPubMedGoogle Scholar
  60. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51:591–8.CrossRefPubMedGoogle Scholar
  61. Messerotti Benvenuti S, Zanatta P, Longo C, Mazzarolo AP, Palomba D. Preoperative cerebral hypoperfusion in the left, not in the right, hemisphere is associated with cognitive decline after cardiac surgery. Psychosom Med. 2012a;74:73–80.CrossRefPubMedGoogle Scholar
  62. Messerotti Benvenuti S, Zanatta P, Valfre C, Polesel E, Palomba D. Preliminary evidence for reduced preoperative cerebral blood flow velocity as a risk factor for cognitive decline three months after cardiac surgery: an extension study. Perfusion. 2012b;27:486–92.CrossRefPubMedGoogle Scholar
  63. Mitchell SJ, Merry AF, Frampton C, Davies E, Grieve D, Mills BP, Webster CS, Milsom FP, Willcox TW, Gorman DF. Cerebral protection by lidocaine during cardiac operations: a follow-up study. Ann Thorac Surg. 2009;87:820–5.CrossRefPubMedGoogle Scholar
  64. Mo Y, Yam FK. Rational use of second-generation antipsychotics for the treatment of ICU delirium. J Pharm Pract. 2017;30:121–9.CrossRefPubMedGoogle Scholar
  65. Moller CH, Penninga L, Wetterslev J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev. 2012;3:CD007224.Google Scholar
  66. Mu JL, Lee A, Joynt GM. Pharmacologic agents for the prevention and treatment of delirium in patients undergoing cardiac surgery: systematic review and metaanalysis. Crit Care Med. 2015;43:194–204.CrossRefPubMedGoogle Scholar
  67. Nathan HJ, Rodriguez R, Wozny D, Dupuis JY, Rubens FD, Bryson GL, Wells G. Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: five-year follow-up of a randomized trial. J Thorac Cardiovasc Surg. 2007;133:1206–11.CrossRefPubMedGoogle Scholar
  68. Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300:1685–90.CrossRefPubMedGoogle Scholar
  69. Nelson DP, Andropoulos DB, Fraser CD Jr. Perioperative neuroprotective strategies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:49–56.
  70. Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64:705–14.CrossRefPubMedPubMedCentralGoogle Scholar
  71. Newman MF, Grocott HP, Mathew JP, White WD, Landolfo K, Reves JG, Laskowitz DT, Mark DB, Blumenthal JA. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke. 2001;32:2874–81.CrossRefPubMedGoogle Scholar
  72. NICE. NCGCU. Delirium: diagnosis, prevention and management [Internet]. NICE Clinical Guidelines, No. 103. Treatment of delirium: non-pharmacological (hospital setting). 2010.
  73. NICE. NIfHaCE. Delirium: quality statement two: interventions to prevent delirium, QS63. London: National Institute for Health and care Excellence. 2014.
  74. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33:66–73.CrossRefPubMedGoogle Scholar
  75. Pulak LM, Jensen L. Sleep in the intensive care unit: a review. J Intensive Care Med. 2016;31:14–23.CrossRefPubMedGoogle Scholar
  76. Reinsfelt B, Westerlind A, Blennow K, Zetterberg H, Ricksten SE. Open-heart surgery increases cerebrospinal fluid levels of Alzheimer-associated amyloid beta. Acta Anaesthesiol Scand. 2013;57:82–8.CrossRefPubMedGoogle Scholar
  77. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996;335:1857–63.CrossRefPubMedGoogle Scholar
  78. Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER. Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010;54:663–77.CrossRefPubMedPubMedCentralGoogle Scholar
  79. Santos E, Cardoso D, Apostolo J, Neves H, Cunha M, Rodrigues M. Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium: a systematic review of quantitative evidence protocol. JBI Database System Rev Implement Rep. 2015;13:83–92.PubMedGoogle Scholar
  80. Sato Y, Laskowitz DT, Bennett ER, Newman MF, Warner DS, Grocott HP. Differential cerebral gene expression during cardiopulmonary bypass in the rat: evidence for apoptosis? Anesth Analg. 2002;94:1389–94.PubMedGoogle Scholar
  81. Schrijver EJ, de Graaf K, de Vries OJ, Maier AB, Nanayakkara PW. Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: a systematic review of current evidence. Eur J Intern Med. 2016;27:14–23.CrossRefPubMedGoogle Scholar
  82. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.CrossRefPubMedGoogle Scholar
  83. Selnes OA, Grega MA, Borowicz LM Jr, Barry S, Zeger S, Baumgartner WA, McKhann GM. Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls. Ann Thorac Surg. 2005;79:1201–9.CrossRefPubMedGoogle Scholar
  84. Selnes OA, McKhann GM. Neurocognitive complications after coronary artery bypass surgery. Ann Neurol. 2005;57:615–21.CrossRefPubMedGoogle Scholar
  85. Serafim RB, Bozza FA, Soares M, do Brasil PE, Tura BR, Ely EW, Salluh JI. Pharmacologic prevention and treatment of delirium in intensive care patients: a systematic review. J Crit Care. 2015;30:799–807.CrossRefPubMedGoogle Scholar
  86. Sheehy AM, Coursin DB, Keegan MT. Risks of tight glycemic control during adult cardiac surgery. Ann Thorac Surg. 2009;88:1384–5; author reply 1385–1386CrossRefPubMedGoogle Scholar
  87. Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW. Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med. 2010;38:2311–8.CrossRefPubMedGoogle Scholar
  88. Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:Cd005563.PubMedGoogle Scholar
  89. Smith PK. Predicting and preventing adverse neurologic outcomes with cardiac surgery. J Card Surg. 2006;21(Suppl 1):S15–9.CrossRefPubMedGoogle Scholar
  90. Sun X, Lindsay J, Monsein LH, Hill PC, Corso PJ. Silent brain injury after cardiac surgery: a review: cognitive dysfunction and magnetic resonance imaging diffusion-weighted imaging findings. J Am Coll Cardiol. 2012;60:791–7.CrossRefPubMedGoogle Scholar
  91. Teslyar P, Stock VM, Wilk CM, Camsari U, Ehrenreich MJ, Himelhoch S. Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients: a meta-analysis. Psychosomatics. 2013;54:124–31.CrossRefPubMedGoogle Scholar
  92. van Dijk D, Spoor M, Hijman R, Nathoe HM, Borst C, Jansen EW, Grobbee DE, de Jaegere PP, Kalkman CJ. Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. JAMA. 2007;297:701–8.CrossRefPubMedGoogle Scholar
  93. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13:R77.CrossRefPubMedPubMedCentralGoogle Scholar
  94. Zhang XY, Liu ZM, Wen SH, Li YS, Li Y, Yao X, Huang WQ, Liu KX. Dexmedetomidine administration before, but not after, ischemia attenuates intestinal injury induced by intestinal ischemia-reperfusion in rats. Anesthesiology. 2012;116:1035–46.CrossRefPubMedGoogle Scholar
  95. Zheng HSA, Yahiaoui-Doktor M, Meissner W, Van Aken H, Zahn P, Pogatzki-Zahn E. Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: a prospective database analysis. PLoS One. 2017;12:e0178659.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiac Anesthesiology Department, Anesthesiology Research Center, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations