Neurological Outcomes Following Cardiac Surgery
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Authors
Mayorga Palacios, Camila
Date
Type
thesis
Language
eng
Keyword
Post-operative Delirium , Post-operative Cognitive Dysfunction , Cardiac Surgery , Robotic Technology , Kinarm EP , Neurological Quantification , Endoscopic Vessel Retrieval , Open Vessel Retrieval , Angiotensin Coverting Enzyme Inhibitor , Angiotensin Receptor Blocker , Neurological impairment , Cognitive Impairment , isolated CABG , Neuroprotection , Hypertension , Depression , Anxiety , Post-operative UTIs , Older age
Alternative Title
Abstract
Neurological complications are known risks in patients undergoing cardiac surgery. While some patients may experience acute impairment (i.e., delirium), others experience long-term postoperative neurological impairment (i.e., Postoperative cognitive dysfunction - POCD). The incidence of delirium ranges from 11-55% depending on the assessment tool. Similarly, POCD is reported to occur in 25-70% of cardiac surgery patients. While the exact etiology for acute or chronic post-operative neurological impairment remains unknown, it is possible to have multifactorial origins including increased inflammation and cerebrovascular dysfunction.
This thesis aimed to investigate the incidence of post-operative delirium between two vessel retrieval approaches (open vs endoscopic) and the effect of preoperative utilization of Angiotensin Receptor Blockers (ARBs) or Angiotensin Converting Enzyme inhibitors (ACEi) on the development of POCD as quantified by the Kinarm End-Point (EP). The Kinarm EP is a robotic assessment that quantifies sensory, motor, and cognitive function. Logistic regression models did not find an increased risk of postoperative delirium associated with undergoing an open vessel retrieval approach. Additionally, the incidence of post- operative delirium between open vessel retrieval (OVR) and endoscopic vessel retrieval (EVR) was not statistically different. Similarly, the 3-month post-operative cognitive performance of patients who utilized preoperative ARBs/ACEi did not differ from patients not on these medications. However, this study did demonstrate the strength of robotic technology in detecting subtle cognitive impairments. Additionally, this thesis highlights preoperative depression or anxiety, hypertension, age and post-operative UTIs as risk factors of post-operative delirium. These finding support existing theorized pathophysiological mechanisms of delirium and POCD. It also provides possible clinically relevant risk factors that may be utilized in the prevention of postoperative delirium following cardiac surgery. The translation of ARBs/ACEi into the treatment of neurological impairment requires further research as current literature remains inconclusive.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution 3.0 United States