NEUROPSYCHOLOGICAL DYSFUNCTION FOLLOWING ELECTIVE CARDIAC OPERATION .1. EARLY ASSESSMENT

  • 1 January 1982
    • journal article
    • research article
    • Vol. 84  (4) , 585-594
Abstract
Two neuropsychological tests were administered to 227 men and women, ages 25-69 yr, 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 Test and the Visual Reproduction (VR) Test of the Wechsler Memory Scale (WMS). Postoperative decrements > 1 SD were observed in each of the 4 scores derived from these testings for 11-17% of the patients. Yet 70% of all patients remained within 1 SD of original performance on all 4 scores. Among the preoperative correlates of significantly reduced test performance were > 60 yr, end-diastolic pressure > 30 mm Hg, moderate to serverly 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 > 7 h, time on the pump > 2 and aortic cross-clamp time > 2 h), total estimate of blood loss > 2000 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. Those patients with more precarious heart function, a more protracted operation and/or increased metabolic disturbances are especially prone to neuropsychological dysfunction following caridac operations.

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