ABSTRACT
Cerebral damage remains one of the hazards related to cardiac surgery with cardiopulmonary bypass. The use of biochemical markers of cerebral injury may be of practical value. We investigated the plasma release patterns of S-100 protein and neuron-specific enolase (NSE) during the intervention and their relationship with the development of neuropsychological deficits assessed 6 months after the intervention in 16 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Both S-100 and NSE significantly increased peri- and postoperatively. Significant correlations were found between values measured at several time points and impaired performance in a few tests at the 6-month follow-up. A stratification into two age subgroups led to the hypothesis that age might have a confounding or a modifying effect on the association between S-100 and NSE levels, and cognitive impairment.
Subject(s)
Cognition Disorders/etiology , Coronary Artery Bypass/adverse effects , Hypoxia-Ischemia, Brain/blood , Hypoxia-Ischemia, Brain/diagnosis , Phosphopyruvate Hydratase/blood , S100 Proteins/blood , Aged , Biomarkers/blood , Cognition Disorders/blood , Female , Follow-Up Studies , Humans , Hypoxia-Ischemia, Brain/complications , Hypoxia-Ischemia, Brain/enzymology , Hypoxia-Ischemia, Brain/etiology , Male , Middle Aged , Neurologic Examination , Neuropsychological Tests , Prospective StudiesSubject(s)
Anesthesia, Intravenous , Lung Diseases/surgery , Monitoring, Intraoperative , Oxygen/blood , Aged , Female , Humans , Male , Middle Aged , VeinsABSTRACT
Two groups of patients were prospectively studied to evaluate the hemostatic effects of high-dose aprotinin in open heart operations. Group A patients (n = 22) received aprotinin during the entire surgical procedure. Group B patients (n = 12) served as controls. The groups were homogeneous for base variables and for cardiopulmonary bypass duration. Postoperative bleeding was lower in group A (mean, 486 mL) than in group B (830 mL) (p less than 0.01). The need for banked blood decreased by approximately half in the aprotinin patients (mean: group A, 213 mL; group B, 409 mL). Hemoglobin levels were similar in the two groups (postoperative day 7: group A, 11.29 g/100 mL; group B, 11.26 g/100 mL; NS). Platelet count decreased at the end of operation in both groups (99,000 and 95,000/mL, respectively; NS) and then increased beyond baseline levels before discharge. No complications were observed that could be attributed to aprotinin. In conclusion, we believe that the use of high-dose aprotinin is safe and effective. It decreases blood loss and reduces the need for banked blood in cardiac operations, particularly in select groups of patients (eg, those undergoing reoperation, Jehovah's Witnesses, those with renal failure).
