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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 585-594, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA Savageau, BA Stanton, CD Jenkins and MD Klein
Two neuropsychological tests were administered to 227 men and women, ages
25 to 69 years, before and after coronary bypass and cardiac valve
operations to provide current information regarding the incidence of
postoperative decrements in neuropsychological dysfunction and the factors
associated with them. Biographical, psychological, and medical- surgical
data were studied together with changes in scores on the Trail Making Tests
and the Visual Reproduction (VR) Test of the Wechsler Memory Scale (WMS).
Postoperative decrements greater than one standard deviation were observed
in each of the four scores derived from these testings for 11% to 17% of
the patients. Yet 70% of all patients remained within one standard
deviation of original performance on all four scores. Among the
preoperative correlates of significantly reduced test performance were age
greater than 60 years, end-diastolic pressure greater than 30 mm Hg,
moderate to severely enlarged heart size on preoperative x-ray film, and
use of propranolol or chlordiazepoxide hydrochloride. Significant
perioperative correlates included measure of duration of operation (such as
total time of operation greater than 7 hours, time on the pump greater than
2 hours, and aortic cross-clamp time greater than 2 hours), total estimate
of blood loss greater than 2,000 ml, hypotension, difficult intubation, and
insertion of an intra- aortic balloon. Postoperative factors significantly
associated with declines in test scores included electrolyte (Na+, K+, Cl-)
abnormalities, longer stay in the intensive care unit, bizarre behavior or
disorientation, and depression score. These findings suggest that those
patients with more precarious heart function, a more protracted operation,
and/or increased metabolic disturbances are especially prone to
neuropsychological dysfunction following cardiac operations.
ARTICLES
Neuropsychological dysfunction following elective cardiac operation. I. Early assessment
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