The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery

Introduction: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. M...

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Main Authors: Pinar Kurnaz, Zerrin Sungur, Emre Camci, Nukhet Sivrikoz, Gunseli Orhun, Mert Senturk, Omer Sayin, Emin Tireli, Hakan Gurvit
Format: Article
Language:English
Published: Elsevier 2017-05-01
Series:Brazilian Journal of Anesthesiology
Online Access:http://www.sciencedirect.com/science/article/pii/S0104001416300483
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author Pinar Kurnaz
Zerrin Sungur
Emre Camci
Nukhet Sivrikoz
Gunseli Orhun
Mert Senturk
Omer Sayin
Emin Tireli
Hakan Gurvit
author_facet Pinar Kurnaz
Zerrin Sungur
Emre Camci
Nukhet Sivrikoz
Gunseli Orhun
Mert Senturk
Omer Sayin
Emin Tireli
Hakan Gurvit
author_sort Pinar Kurnaz
collection DOAJ
description Introduction: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. Methods: 40 patients older than 50 years undergoing elective coronary surgery were randomized into two groups. In the “Tight Control” group (GI), the glycemia was maintained between 80 and 120 mg dL−1 while in the “Liberal” group (GII), it ranged between 80–180 mg dL−1. A neuropsychological test battery was performed three times: baseline before surgery and follow-up first and 12th weeks, postoperatively. POCD was defined as a drop of one standard deviation from baseline on two or more tests. Results: At the postoperative first week, neurocognitive tests showed that 10 patients in the GI and 11 patients in GII had POCD. The incidence of early POCD was similar between groups. However the late assessment revealed that cognitive dysfunction persisted in five patients in the GII whereas none was rated as cognitively impaired in GI (p = 0.047). Conclusion: We suggest that tight perioperative glycemic control in coronary surgery may play a role in preventing persistent cognitive impairment. Resumo: Introdução: A disfunção cognitiva pós-operatória (DCPO) é um resultado adverso cirúrgico que é mais comum após cirurgias cardíacas abertas. O objetivo deste estudo foi investigar o papel dos níveis de glicose no sangue rigorosamente controlados durante a cirurgia coronariana no declínio cognitivo precoce e tardio. Métodos: Quarenta pacientes com idades acima de 50 anos e submetidos à cirurgia coronariana eletiva foram randomizados em dois grupos. No grupo “controle rigoroso” (GI), a glicemia foi mantida entre 80-120 mg.dL−1; enquanto no grupo “liberal” (GII), variou entre 80-180 mg.dL−1. A bateria de testes neuropsicológicos foi realizada três vezes: fase basal, antes da cirurgia e na primeira e décima segunda semana de acompanhamento no pós-operatório. DCPO foi definida como uma queda de um desvio padrão da fase basal em dois ou mais testes. Resultados: Na primeira semana de pós-operatório, os testes neurocognitivos mostraram que 10 pacientes no GI e 11 pacientes no GII apresentaram DCPO. A incidência de DCPO precoce foi semelhante entre os grupos. No entanto, a avaliação tardia revelou que a disfunção cognitiva persistiu em cinco pacientes no GII, enquanto nenhum paciente foi classificado como cognitivamente prejudicado no GI (p = 0,047). Conclusão: Sugerimos que o controle glicêmico rigoroso no perioperatório de cirurgia coronariana pode desempenhar um papel na prevenção da deterioração cognitiva persistente. Keywords: Glucose control, Cognitive dysfunction, Coronary artery bypass surgery, Palavras-chave: Controle glicêmico, Disfunção cognitiva, Cirurgia de revascularização do miocárdio
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spelling doaj.art-7832aea6d3b9489db25e8495ab0458542022-12-22T03:33:30ZengElsevierBrazilian Journal of Anesthesiology0104-00142017-05-01673258265The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgeryPinar Kurnaz0Zerrin Sungur1Emre Camci2Nukhet Sivrikoz3Gunseli Orhun4Mert Senturk5Omer Sayin6Emin Tireli7Hakan Gurvit8Istanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, Turkey; Corresponding author.Istanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Anesthesiology, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Cardiac Surgery, Istanbul, TurkeyIstanbul University Istanbul Medical Faculty, Department of Neurology, Istanbul, TurkeyIntroduction: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. Methods: 40 patients older than 50 years undergoing elective coronary surgery were randomized into two groups. In the “Tight Control” group (GI), the glycemia was maintained between 80 and 120 mg dL−1 while in the “Liberal” group (GII), it ranged between 80–180 mg dL−1. A neuropsychological test battery was performed three times: baseline before surgery and follow-up first and 12th weeks, postoperatively. POCD was defined as a drop of one standard deviation from baseline on two or more tests. Results: At the postoperative first week, neurocognitive tests showed that 10 patients in the GI and 11 patients in GII had POCD. The incidence of early POCD was similar between groups. However the late assessment revealed that cognitive dysfunction persisted in five patients in the GII whereas none was rated as cognitively impaired in GI (p = 0.047). Conclusion: We suggest that tight perioperative glycemic control in coronary surgery may play a role in preventing persistent cognitive impairment. Resumo: Introdução: A disfunção cognitiva pós-operatória (DCPO) é um resultado adverso cirúrgico que é mais comum após cirurgias cardíacas abertas. O objetivo deste estudo foi investigar o papel dos níveis de glicose no sangue rigorosamente controlados durante a cirurgia coronariana no declínio cognitivo precoce e tardio. Métodos: Quarenta pacientes com idades acima de 50 anos e submetidos à cirurgia coronariana eletiva foram randomizados em dois grupos. No grupo “controle rigoroso” (GI), a glicemia foi mantida entre 80-120 mg.dL−1; enquanto no grupo “liberal” (GII), variou entre 80-180 mg.dL−1. A bateria de testes neuropsicológicos foi realizada três vezes: fase basal, antes da cirurgia e na primeira e décima segunda semana de acompanhamento no pós-operatório. DCPO foi definida como uma queda de um desvio padrão da fase basal em dois ou mais testes. Resultados: Na primeira semana de pós-operatório, os testes neurocognitivos mostraram que 10 pacientes no GI e 11 pacientes no GII apresentaram DCPO. A incidência de DCPO precoce foi semelhante entre os grupos. No entanto, a avaliação tardia revelou que a disfunção cognitiva persistiu em cinco pacientes no GII, enquanto nenhum paciente foi classificado como cognitivamente prejudicado no GI (p = 0,047). Conclusão: Sugerimos que o controle glicêmico rigoroso no perioperatório de cirurgia coronariana pode desempenhar um papel na prevenção da deterioração cognitiva persistente. Keywords: Glucose control, Cognitive dysfunction, Coronary artery bypass surgery, Palavras-chave: Controle glicêmico, Disfunção cognitiva, Cirurgia de revascularização do miocárdiohttp://www.sciencedirect.com/science/article/pii/S0104001416300483
spellingShingle Pinar Kurnaz
Zerrin Sungur
Emre Camci
Nukhet Sivrikoz
Gunseli Orhun
Mert Senturk
Omer Sayin
Emin Tireli
Hakan Gurvit
The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
Brazilian Journal of Anesthesiology
title The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
title_full The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
title_fullStr The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
title_full_unstemmed The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
title_short The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
title_sort effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery
url http://www.sciencedirect.com/science/article/pii/S0104001416300483
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