Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000400016
Brazilian Journal of Anesthesiology
Review Article

Lesão neurológica em cirurgia cardíaca: aspectos fisiopatológicos

Pathophysiology of neurological injuries during heart surgery: aspectos fisiopatológicos

Rólison Gustavo Bravo Lelis; José Otávio Costa Auler Júnior

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Resumo

JUSTIFICATIVA E OBJETIVOS: Em virtude de as lesões neurológicas ocuparem um papel importante no contexto das complicações pós-operatórias, quando comparadas às demais, o presente estudo procurou discutir os principais fatores envolvidos na lesão neurológica peri-operatória em cirurgia cardíaca, as intervenções que buscam diminuir a incidência de lesões neurológicas, enfocando de maneira simples, e a provável gênese genética em tais lesões encefálicas. CONTEÚDO: Este trabalho contém a revisão de artigos que enfocam a fisiopatologia das lesões neurológicas relacionadas a procedimentos cardíacos, sua possível origem genética, bem como uma proposta para sua prevenção. CONCLUSÕES: Muito tem se falado das disfunções cognitivas de pacientes após cirurgia cardíaca, como a revascularização do miocárdio que é motivo do aumento da morbimortalidade observada atualmente e fator de maior tempo de hospitalização. É fato que já houve grandes avanços nessa área a fim de diminuir esses índices, prevendo-se ainda outros que visam a profilaxia de lesões neurológicas.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Since neurological injuries are very concerning and important postoperative complications following cardiac surgeries, the purpose of this study was to discuss the pathophysiology of these injuries, what measures can be taken to decrease their incidence and the possible genetic origin of such brain injuries. CONTENTS: This study is a review of papers which address the pathophysiology of heart surgery-related neurological injuries and their possible genetic origin, as well as some proposals for their prevention. CONCLUSIONS: A lot has been said about cognitive function disorders after heart surgeries, such as myocardial revascularization, which are present causes of increased morbidity and mortality, in addition to longer hospital stay. Major advances to decrease such rates have been observed in this field, and others are still expected aiming at neurological injuries prevention.

Keywords

COMPLICATIONS, COMPLICATIONS, SURGERY, SURGERY

Referências

Mangano DT. Cardiovascular morbidity and CABG surgery - a perspective: epidemiology, costs, and potential therapeutic solutions. J Card Surg. 1995;10:(Suppl4):366-368.

Moller JT, Cluitmans P, Rasmussen LS. Long term postoperative cognitive dysfunction in the elderly ISPOCD1 study: ISPOCD investigators. International study of postoperative cognitive dysfunction. Lancet. 1998;351(9106):857-861.

Shaw PJ, Bates D, Cartlidge NE. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke. 1987;18:700-707.

Roach GW, Kanchuger M, Mangano CM. 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;335:1857-1863.

Wolman RL, Nussmeier NA, Aggarwal A. Cerebral injury after cardiac surgery: identification of a group at extraordinary risk. Multicenter study of perioperative ischemia research group (McSPI) and the ischemia research Education Foundation (IREF) Investigators. Stroke. 1999;30:514-522.

Taggart DP, Browne SM, Halligan PW. Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?. J Thorac Cardiovasc Surg. 1999;118:414-421.

Linden J, Casimir-Ahn H. When do cerebral emboli appear during open heart operations?. A transcranial Doppler study. Ann Thorac Surg. 1991;51:237-241.

Cook DJ. Neurologic Effects. Cardiopulmonary Bypass: Principle and Practice. 2000:403-431.

Arrowsmith JE, Grocott HP, Reves JG. Central nervous system complications of cardiac surgery. Br J Anaesth. 2000;84:378-393.

Martin TD, Craver JM, Gott JP. Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. Ann Thorac Surg. 1994;57:298-304.

Randomized trial of normothermic versus hypothermic coronary bypass surgery. Lancet. 1994;343(8897):559-563.

Gold JP, Charlson ME, Williams-Russo P. Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg. 1995;110:1302-1314.

Souter MJ, Andrews PJ, Alston RP. Propofol does not ameliorate cerebral venous oxyhemoglobin desaturation during hypothermic cardiopulmonary bypass. Anesth Analg. 1998;86:926-931.

Zimmer DB, Cornwall EH, Landar A. The S100 protein family: history, function, and expression. Brain Res Bull. 1995;37:417-429.

Jönsson H, Johnsson P, Alling C. Significance of serum S100 release after coronary artery bypass grafting. Ann Thorac Surg. 1998;65:1639-1644.

Reynolds JD, Amory DW, Grocott HP. Change in plasma glutamate concentration during cardiac surgery is a poor predictor of cognitive outcome. J Cardiothorac Vasc Anesth. 2002;16:431-436.

Nevin M. Neuropsychometric deficit after cardiac surgery: a new approach for a new millennium. Br J Anaesth. 2000;84:304-307.

Jorde LB, Carey JC, Bamshad MJ. Medical Genetics. 1999:231-232.

Ti LK, Mathew JP, Mackensen GB et al. Effect of apolipoprotein E genotype on cerebral autoregulation during cardiopulmonary bypass. Stroke. 2001;32:1514-1519.

Drabe N, Zund G, Grunenfelder J et al. Genetic predisposition in patients undergoing cardiopulmonary bypass surgery is associated with an increase of inflammatory cytokines. Eur J Cardiothorac Surg. 2001;20:609-613.

Auler Jr JOC. Neurologic Complications in Cardiac Surgery: Is Predictable?. Anaesthesia Pain Intensive Care and Emergency: A.P.I.C.E.. 2002:983-990.

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