Résumé
Despite significant advances in cardio-pulmonary bypass [CPB] technology, surgical technique, and anaesthetic management, central nervous system complications occur in a large percentage of patients undergoing surgery requiring CPB. A major neurologic complication after otherwise successful surgery represents a devastating outcome for both the patient and the immediate family. The social and economic impact of unemployment and the requirement for long-term rehabilitation or institutional care are significant. Neuron-specific enolase [NSE] is a biochemical brain marker which can be used for the prediction of adverse neurologic outcome after cardiac surgery. This study included 60 adult patients of both sexes scheduled for elective cardiac surgery. Standard CPB technique with membrane oxygenator, nonpulsatile flow, and mean arterial pressure control was used. Neuropsychological evaluation was performed before surgery and post-operatively at discharge and after three months. Neuron-specific enolase[NSE] was measured after induction of anaesthesia, at end of CPB, 24 hours and 48 hours after CPB. After 5 days of surgery 21.8% of patients developed neuropsychiatric dysfunction. However, after 3 months only 10.9% of patients developed neuropsychiatric dysfunction. The NSE values at the end of surgery and 24 hours after surgery in patients who developed neuropychiatric dysfunction were significantly higher than those who did not develop neuropsychiatric dysfunction at 5 days and 3 months after surgery. The serum levels of NSE sampled at the end of surgery or 24 hours after surgery could be of a valid clinical predictor for adverse neuropsychiatric outcome in patients undergoing cardiac surgery