High Spinal Anesthesia and Delirium Incidence After Cardiac Surgery
CCCF ePoster library. Petropolis A. Oct 27, 2015; 117369; P65
Andrea Petropolis
Andrea Petropolis
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Abstract
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P65


Topic: Retrospective or Prospective Cohort Study


High Spinal Anesthesia and Delirium Incidence After Cardiac Surgery



Andrea Petropolis, D. Maguire, H. Grocott, R. Arora, T. Lee, S. Kowalski

Department of Anesthesia, Saint Michael's Hospital, University of Toronto, Toronto, Canada | Department of Anesthesia, University of Manitoba, Winnipeg, Canada | Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada | Department of Surgery, University of Manitoba, Toronto, Canada | Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada | Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada

Introduction: Delirium is a syndrome of acute brain dysfunction that commonly occurs in the postoperative period. [1] The pathophysiology of delirium is poorly understood, however there is general agreement that it is multifactorial in its etiology. [1] Inflammation may play an important role in the pathogenesis of delirium, particularly in the setting of cardiac surgery, which is known to have an exaggerated inflammatory response. [1,2,3] Certain interventions, including high spinal anesthesia (HSA), may attenuate the inflammatory response to cardiac surgery. [4,5,6]

Objectives: The aim of this study was to determine the impact of HSA on the incidence of delirium after cardiac surgery.


Methods: Following Research Ethics Board approval, we conducted a retrospective analysis of all patients who received HSA for cardiac surgery at our institution from March 1st 2010 to March 30th 2014. Each HSA case was algorithmically matched to a non-HSA case from the same time period using a database which included 2300 cardiac surgery cases. Matching was based on a number of pre-defined preoperative and intraoperative delirium risk factors. The primary outcome was the incidence of delirium, which was defined as any positive Confusion Assessment Method (CAM) or CAM-ICU score on postoperative days zero to seven (POD 0-7). Our secondary outcome was delirium severity, which was determined by the average number of days in hospital (POD 0-7) on which a positive CAM score was recorded.

Results: Delirium occurred in 8% (11/137) of patients in the HSA group, as compared to 18% (23/130) in the control group (relative risk [RR] 0.45, 95% CI 0.23 to 0.89). Average (mean ± SD) number of days with delirium was not significantly different between groups (0.1 ± 0.6 vs. 0.3 ± 0.9 days in HSA vs. controls; p = 0.87)

Conclusion: Compared to a matched control group, HSA patients had a significant decrease in the incidence of post-cardiac surgical delirium. The reasons for this decrease are not known but might be related to a reduction in the inflammatory response or due to differences in anesthetic management inherent with the use of HSA.

References:
  1. Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C: Delirium in the Postoperative Cardiac Patient: A Review. J Card Surg 20:560-567, 2005
  2. Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL: Delirium after Coronary Artery Bypass Graft Surgery and Late Mortality. Ann Neurol 67:338-44, 2010
  3. Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB: The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119:737-754, 2010
  4. Lee TW: Regional anesthesia. In: Mackay J, Arrowsmith JE (Eds). Core Topics in Cardiac Anesthesia 2nd Ed. New York, USA: Cambridge University Press; 2012:453-457
  5. Lee TW, Grocott HP, Schwinn D, Jacobsohn E: High Spinal Anesthesia for Cardiac Surgery: Effects on beta-Adrenergic Receptor Function, Stress Response, Hemodynamics. Anesthesiology 98:499-510, 2003
  6. Kowalski S, Lee T, Maguire D, Freed D, HayGlass K, Falk K: Spinal Anesthesia, hemodynamics, inflammation in CABG and AVR. http://umanitoba.ca/faculties/medicine/units/anesthesia/media/ Kowalski_Abstract.pdf. Accessed October 7, 2012
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