HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sahu, B. Articles by Nehra, A. Search for Related Content PubMed Articles by Sahu, B. Articles by Nehra, A. Related Collections Anesthesia Cerebral protection Congenital - cyanotic Extracorporeal circulation

Neuropsychological function in children with cyanotic heart disease undergoing corrective cardiac surgery: effect of two different rewarming strategies

^a Department of Cardiac Anaesthesiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India
^b Department of Cardiovascular & Thoracic Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India
^c Department of Cardiac Biochemistry, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India
^d Department of Clinical Psychology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India

Received 20 June 2008; received in revised form 19 October 2008; accepted 29 October 2008.

^_* Corresponding author. Address: Department of Cardiac Anaesthesia, C N Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Tel.: +91 9313869106. (Email: drbikash_sahu{at}rediffmail.com).

Objective: Hypothermia conventionally used in cardiopulmonary bypass necessitates rewarming to normothermic temperatures, which has been shown to be associated with neuropsychological injury. We studied the effects of two different rewarming strategies on postoperative neuropsychological function in cyanotic paediatric patients undergoing elective primary intracardiac repair of tetralogy of Fallot with the aid of cardiopulmonary bypass. Methods: This was a randomised clinical study undertaken in the cardiothoracic centre of a tertiary level referral and teaching hospital. Eighty children, aged 6–15 years undergoing elective primary intracardiac repair of tetralogy of Fallot using cardiopulmonary bypass under moderate hypothermia at 28 °C were included in this study. The patients were randomly allocated into two groups of 40 each. Group 1 patients were rewarmed to a nasopharyngeal temperature of 33 °C while group 2 patients were rewarmed to a nasopharyngeal temperature of 37 °C before weaning them off cardiopulmonary bypass. The anaesthetic and bypass management was standardised for both the groups. All patients were assessed for neuropsychological function preoperatively and on the fifth postoperative day using the MISIC tests. The amount of blood loss and need for blood and blood product transfusion postoperatively, need for pacing, increased inotropes or vasodilator use and time to extubation were also noted. Serum s-100β levels were measured post anaesthetic induction and at 24 h postoperatively. Results: There was a significant deterioration in neuropsychological function postoperatively in the patients in group 2 (37 °C) as compared to their preoperative function. This was associated with higher s-100β levels 24 h postoperatively in group 2 (37 °C) compared to group 1 (33 °C) patients. The time to extubation was longer in group 1 (33 °C). No significant differences were noted in the amount of postoperative blood loss, blood and blood product use, inotrope or vasodilator use and the need for pacing. Conclusion: Weaning off bypass at 33 °C is associated with lesser postoperative neuropsychological dysfunction compared to rewarming to 37 °C before weaning off bypass. This may be used as a tool to decrease neurologic morbidity following cardiac surgery in children with congenital cyanotic heart disease.

Key Words: Rewarming • Neuropsychological function • Cyanotic heart disease • s-100β