Journal of Isfahan Medical School

Journal of Isfahan Medical School

Association of Mean Arterial Pressure during Cardiopulmonary Pump and Incidence of Delirium after Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors
Keyvan Bagheri 1
Azim Honarmand 2
Seyed Jamaleddin Hosseini-Moosa 3
1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, School of Medicine, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Despite improved outcomes after cardiac operations, delirium is a common neurologic complication after cardiac surgery. In this study, we aimed to investigate the association of postoperative delirium and mean arterial pressure (MAP) during cardiopulmonary pump in patients after coronary artery bypass graft (CABG).Methods: 100 inpatients submitted to coronary artery bypass graft were evaluated prior to and after surgery. In order to investigate the association between mean arterial pressure and incidence of delirium, data were collected at pre intra, and postoperative periods. The patients were examined for delirium using Mini-Mental State Examination (MMSE).Findings: Preoperative delirium was detected in 34 patients (34%) and 74 patients (74%) had postoperative delirium. There was a significant positive correlation between total score of MMSE and mean arterial pressure during cardiopulmonary pump (r = +0.22, P = 0.02). Furthermore, there was a significant correlation between total score of MMSE and O2 saturation (r = +0.22, P = 0.03).Conclusion: Present study suggests associations between incidence of postoperative delirium and mean arterial pressure and O2 saturation during cardiopulmonary pump. Maintaining mean arterial pressure and O2 saturation of blood at physiologic levels during cardiopulmonary pump may be associated with less early postoperative delirium and cognitive dysfunction.
Keywords
Coronary Artery Bypass Grafting
Delirium
Mean arterial pressure
  1. Deppe AC, Weber C, Liakopoulos OJ, Zeriouh M, Slottosch I, Scherner M, et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients. J Card Surg 2017; 32(3): 177-85.
  2. Arumugam S, El-Menyar A, Al-Hassani A, Strandvik G, Asim M, Mekkodithal A, et al. Delirium in the intensive care unit. J Emerg Trauma Shock 2017; 10(1): 37-46.
  3. Crocker E, Beggs T, Hassan A, Denault A, Lamarche Y, Bagshaw S, et al. Long-term effects of postoperative delirium in patients undergoing cardiac operation: A systematic review. Ann Thorac Surg 2016; 102(4): 1391-9.
  4. Horacek R, Krnacova B, Prasko J, Latalova K. Delirium as a complication of the surgical intensive care. Neuropsychiatr Dis Treat 2016; 12: 2425-34.
  5. Kanova M, Sklienka P, Roman K, Burda M, Janoutova J. Incidence and risk factors for delirium development in ICU patients - a prospective observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161(2): 187-96.
  6. Modabernia M, Forghan parast K, Khalkhali S, Najafi K. Delirium in CCU. J Guilan Univ Med Sci 2002; 11(41): 1-6. [In Persian].
  7. Siepe M, Pfeiffer T, Gieringer A, Zemann S, Benk C, Schlensak C, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. Eur J Cardiothorac Surg 2011; 40(1): 200-7.
  8. Seyedian M, Falah M, Nourouzian M, Nejat S, Delavar A, Ghasemzadeh Ha. Validity of the Farsi version of mini-mental state examination. J Med Counc I R Iran 2008; 25(4): 408-14. [In Persian].
  9. Lopez MG, Pandharipande P, Morse J, Shotwell MS, Milne GL, Pretorius M, et al. Intraoperative cerebral oxygenation, oxidative injury, and delirium following cardiac surgery. Free Radic Biol Med 2017; 103: 192-8.
  10. Li HC, Chen YS, Chiu MJ, Fu MC, Huang GH, Chen CC. Delirium, subsyndromal delirium, and cognitive changes in individuals undergoing elective coronary artery bypass graft surgery. J Cardiovasc Nurs 2015; 30(4): 340-5.
Journal of Isfahan Medical School
Volume 35, Issue 449 - Serial Number 449
September and October 2017
Pages 1358-1363

  • Receive Date 19 April 2017
  • Accept Date 06 April 2022