Nadzor i zaštita moždane funkcije u kardiokirurškoj anesteziji

master's thesis

• Title (english): Monitoring and protection of brain function in cardiac anaesthesia
• Author: Dora Ivanković
• Mentor: Željko Čolak (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Željko Čolak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Kardiokirurški zahvati povezani su s visokom učestalosti neuroloških komplikacija, usprkos napretku kirurgije i anestezije. Ishemijska ili hipoperfuzijska ozljeda mozga nakon zahvata manifestira se različitim neurološkim poremećajima, od moždanog udara, encefalopatije i delirija do slabljenja kognitivnih funkcija. Bez obzira na nisku incidenciju, moždani udar je vrlo ozbiljna posljedica zahvata i uzrok trajne nesposobnosti. Učestalost postoperativnog delirija može biti i do polovice broja odraslih osoba podvrgnutih općoj anesteziji i operaciji. Delirij se očituje promjenom mentalnog stanja, smanjenom svijesti i pozornosti te poremećajem kognicije, a povezan je s lošijim ishodom. Postoperativni kognitivni poremećaj također je česta komplikacija operacije srca, pogotovo u starijih i rizičnih pacijenata. Dijagnoza se postavlja nizom neuropsihometrijskih testova prije i nakon operacije, što se još uvijek radi samo u svrhu kliničkih istraživanja. Uzroci neuroloških komplikacija nakon kardiokirurške anestezije uključuju kombinaciju embolije, hipoperfuzije i upalnog odgovora, podležeće bolesti krvnih žila te mogućeg poremećaja moždane autoregulacije, što sve čini mozak vrlo podložnim ishemijskoj ozljedi. Postoje brojni uređaji za nadzor mozga, koji mogu neinvazivno i kontinuirano pratiti električnu aktivnost mozga (EEG, evocirani potencijali), moždani protok (TCD) i oksigenaciju (NIRS). Nadzor mozga tijekom anestezije i korekcija navedenih parametara mogli bi pomoći u smanjenju rizika od postoperativnih neuroloških komplikacija. Zaštita mozga postiže se intraoperativnom regulacijom temperature, acido-bazne ravnoteže, adekvatnog protoka i oksigenacije mozga. Epiaortni ultrazvuk služi za prevenciju embolije i pomaže u lokalizaciji plakova na uzlaznoj aorti. Nadalje, mnogi lijekovi pokazali su se učinkoviti u zaštiti mozga u pretkliničkim istraživanjima. Anestetici djeluju na moždani protok i autoregulaciju te smanjuju metabolizam kisika i hranjivih tvari. Neuroprotektivna svojstva drugih lijekova u kardiokirurškoj anesteziji intenzivno se proučavaju.

Abstract (english)

Cardiac surgery is associated with high incidence of neurological complications, despite the significant improvement in surgery and anaesthesia. Ischemic or hypoperfusion injury is manifested by various postoperative neurological impairments, from stroke, encephalopathy and delirium, to impaired cognitive function. Despite the low incidence, stroke is a very serious consequence of the surgical procedure and it causes permanent disability. Almost half of adult patients exposed to general anaesthesia and surgery may experience postoperative delirium in the intensive care unit. Delirium commonly manifests as a change in mental state, decreased consciousness and attention, cognitive impairment, and is associated with adverse outcomes. Postoperative cognitive impairment is also a common complication of cardiac surgery, especially in the elderly and high-risk patients. The diagnosis is made using a standard neuropsychometric test battery before and after the surgery, which is still used only for research purposes. Causes of neurological complications after cardiac anaesthesia include a combination of embolism, hypoperfusion and inflammatory response, underlying vascular disease and possible autoregulation impairment, all of which make the brain highly susceptible to ischemic injury. There are various brain monitoring devices, that non-invasively and continuously assess the brain electrical activity (EEG, evoked potentials), cerebral blood flow (TCD) and oxygenation (NIRS). Monitoring the brain during anaesthesia and correction of these parameters could help reducing the risk of postoperative neurological complications. Brain protection is achieved by intraoperative temperature and acid-base balance, adequate blood flow regulation and oxygenation of the brain. Epiaortic ultrasound prevents embolism and detects atherosclerotic plaques on the ascending aorta. Furthermore, many drugs have been shown useful for protecting the brain in preclinical studies. Anaesthetics affect the brain blood flow, autoregulation and reduce the metabolism. Neuroprotective properties of other drugs in cardiac anaesthesia are being intensively studied.

• Keywords: kardiokirurgija; nadzor mozga; zaštita mozga; kardiokirurška anestezija
• Keywords (english): cardiac surgery; neuromonitoring; neuroprotection; cardiac anaesthesia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:223987
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-07-30 12:39:57