Bukauskienė, Rasa

Background and objectives: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with endothelial glycocalyx injury and perioperative endothelial dysfunction. Syndecan-1 is commonly used as a biomarker of glycocalyx shedding, but data on its perioperative changes and their relationship with operative and patient-related factors remain limited. The aim of this study was to evaluate perioperative Syndecan-1 dynamics during coronary artery bypass grafting (CABG) with CPB and to assess associations with ischemia–reperfusion exposure and patient characteristics. Materials and methods: This prospective observational study included 147 patients undergoing elective CABG with CPB. Syndecan-1 concentrations were measured at five time points: before induction of anaesthesia, immediately after aortic cross-clamp application, immediately after aortic declamping, on arrival at the ICU and 24 h after surgery. Perioperative changes were analysed using non-parametric tests, Spearman’s rank correlation analysis and mixed-effects modelling. The study was registered at ClinicalTrials.gov (NCT03491163; registered on 29 March 2018). Results: Syndecan-1 concentrations changed significantly over time (p < 0.001), increasing from a baseline median of 49.74 ng/mL to a peak of 147.78 ng/mL at ICU admission, followed by a partial decline to 65.26 ng/mL at 24 h. Aortic cross-clamp duration was weakly but significantly associated with Syndecan-1 concentration at ICU admission (rs = 0.243, p = 0.003) and with perioperative increases from baseline to ICU admission (ΔS4-1: rs = 0.196, p = 0.017) and from aortic clamping to ICU admission (ΔS4-2: rs = 0.207, p = 0.012). No significant associations were observed between CPB duration and Syndecan-1 concentrations in univariable analyses. In the mixed-effects model, a significant non-linear temporal pattern of Syndecan-1 concentrations was observed (both linear and quadratic time terms, p < 0.001). Male sex (β = 0.247, p = 0.009) and aortic cross-clamp duration (β = 0.016, p = 0.005) were independently associated with higher Syndecan-1 concentrations, whereas smoking status, age, BMI, diabetes status, EuroSCORE II, and CPB duration were not independently associated. Conclusions: Syndecan-1 concentrations increase significantly during cardiac surgery with cardiopulmonary bypass, peaking at ICU admission and partially declining within 24 h. Aortic cross-clamping duration, but not total CPB duration, showed weak associations with glycocalyx shedding. Male sex was independently associated with higher Syndecan-1 concentrations. These findings support ischemia–reperfusion injury as an important contributor to endothelial glycocalyx shedding during cardiac surgery.

Background. A significant numbers of patients undergo Carotid Endarterectomy (CEA) experience cognitive chan- ges in the early postoperative period. The middle cerebral artery (MCA) is susceptible to fluctuations in blood flow velocity (BFV) changes during carotid cross-clamping. BFV can be measured in real time using Transcranial Dopp- ler (TCD) ultrasonography. Postoperative hypoperfusion syndrome is a proven risk factor for delayed neurocognitive recovery (dNCR), intraoperative reductions in cerebral blood flow velocity may contribute to postoperative cogni- tive decline. Aim. The aim of this study was to evaluate the association between MCA BFV fluctuations and delayed neurocogni- tive recovery and identify risk factors for dNCR. Methods. 27 patients without prior neurocognitive disor- ders undergoing CEA in LUHS Hospital, Kaunas Clinics, were enrolled in the study. Adenbrooke cognitive testing was performed prior to surgery and 1 day after surgery. TCD ultrasonography was performed 1 day before surgery and during CEA. Results. 21 patients were examined; 15 (71.4%) male. Ac- cording to the ACE-III test results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). dNCR developed for seven pa- tients (33.3%). ACM BFV was consistently higher in the postoperative dNCR group, with a statistically significant difference observed before carotid cross-clamping (median [min–max]: 43.1 [11.2–75.1] vs 26.4 [11.9–40.0] cm/s; p = 0.043). No statistically significant differences were ob- served at the remaining time points (p < 0.05). Bias-re- duced logistic regression showed that preoperative cogni- tive impairment was the dominant predictor of postoperative dNCR (penalised â » +3.8). In models exclud- ing preoperative cognitive impairment, preoperative demen- tia (â » +1–4), higher pre-clamping ACM BFV (standard- ized â » +0.6), and lower end-of-surgery rSO? (â » –0.04 to –0.17 per 1% increase) showed consistent directional asso- ciations. No predictor reached statistical significance due to limited sample size. Conclusions. Postoperative dNCR occurred in one-third of patients. Higher pre-clamping MCA BFV was associated with postoperative dNCR, suggesting that altered baseline cerebrovascular haemodynamics may play a role in cogni- tive decline. Elevated pre clamping MCA BFV in carotid stenosis reflects a compensatory hyperdynamic flow from collateral circulation. dNCR was most strongly predicted by preoperative cognitive impairment. When preoperative dNCR was excluded from analysis, dementia, higher pre clamping MCA blood flow velocity, and lower end of sur- gery rScO? showed consistent but non-significant associa- tions, likely due to the limited sample size.

Šiuo leidiniu siekiama praplėsti ir pagerinti praktinių metodikų informacini spektrą anesteziologijos ir reanimatologijos rezidentūros studijų sistemoje, pradedant taikyti pakopinių kompetencijų modelį. Tikimasi, kad šios praktinės metodikos padės studijuojant bei įgijant kompetencijų ir suteiks busimiesiems specialistams praktinių žinių. Rekomendacijų medžiaga paremta Lietuvos Respublikos teisės aktais, Pasaulio sveikatos organizacijos, Europos anesteziologijos ir intensyviosios terapijos bei Amerikos anesteziologų draugijos rekomendacijomis, moksliniais tyrimais ir įvairių šalių gerosios praktikos pavyzdžiais. Informacija pateikiama atsižvelgiant į kasdienius iššūkius, su kuriais susiduria kiekvienas anesteziologas. Šis leidinys skirtas tiems, kurie ieško atsakymų į praktinius klausimus, nori tobulinti savo gebėjimus ir užtikrinti pacientų priežiūros kokybę. Tikimės, kad pateikti metodai ne tik padės gydytojams rezidentams efektyviau įveikti klinikines situacijas, bet ir skatins nuolat mokytis bei tobulėti. Autoriai ir rengėjai tikisi, kad pateikta informacija padės sisteminti žinias ir tinkamiausiu būdu taikyti jas praktikoje. Šiame leidinyje pateiktos anesteziologijos metodikos yra pavyzdinės. Aprašyti veiksmai ir metodai neturėtų būti interpretuojami kaip vieninteliai galimi pasirinkimo variantai. Kiekvienas klinikinis atvejis yra individualus. Galutiniai sprendimai turi būti priimami įvertinus konkretų pacientą, jo būklę, gretutines ligas, rizikos veiksnius, numatomos procedūros pobūdį, klinikinę situaciją. Sprendimai privalo remtis galiojančiais teisiniais aktais ir įstaigos vidaus tvarkos taisyklėmis.

Objective: Delayed neurocognitive recovery (dNCR) remains a common complication after surgery and the incidence of it is determined 30-80% after cardiac surgery with cardiac bypass (CPB) in eldery patients. Many researchers have identified that neuropsychological complications emerge from insufficient cerebral perfusion. Relative cerebral hyperperfusion also disrupts cerebral autoregulation and might play a significant role in dNCR development. The aim of this study is to determine hyperperfusion in the middle cerebral artery during CPB influence to dNCR development and brain biomarker glial fibrillary acidic protein (GFAP) impact in diagnosing dNCR. Designs and methods: This prospective - case control study included patients undergoing elective coronary artery bypass grafting or/and valve surgery with CPB. For cognitive evaluation 101 patients completed Addenbrooke's cognitive examination - ACE-III. To determine mild cognitive dysfunction, cut - off 88 was chosen. Mean BFV was monitored with transcranial Doppler ultrasonography (TCD) and performed before surgery, after induction of anaesthesia, during CPB and after surgery. Preoperative BFV was converted to 100% and used as a baseline. The percentage change of cerebral blood flow velocity during CPB was calculated from baseline. Patients with decreased blood flow velocity were included for further investigation. To measure glial fibrillary acidic protein, blood samples were collected after anaesthesia induction, 24 and 48 h after the surgery. According to the ACE-III test results, patients with relative hyperperfusion were divided into two groups: with Delayed neurocognitive recovery and without dNCR (non-dNCR group). Results: 101 patients were examined, 67 (69.1%) men and 29 (29.9%) women, age 67.9 (SD 9.2) Increased percentage of BFV was determined for 40 (39.60%) patients. There were no differences in sex, haematocrit, paCO2, aortic cross-clamping or CPB time between the two groups. Percentage change of BFV was 105.60% in the non-dNCR group and 132.29% in the dNCR group, p = .033. Patients who developed dNCR in the early post-surgical period were significantly older, p < .001 and had a lower baseline of BFV, p = .004. GFAP concentration significantly increased in the dNCR group 48 hours after surgery, compared to the non-dNCR group, p = .01. Conclusions: Relative hyperperfusion during CPB may cause dNCR. Elderly patients are sensitive to blood flow velocity acceleration during CPB. GFAP concentration increased 48 h after surgery in dNCR group but did not have any connection with risk factors.

Objective: Inflammation, neuronal, vascular damage/embolism, cerebral autoregulation and perfusion, oxygen delivery are known as etiological factors of delayed neurocognitive recovery (dNCR). Many researchers have identified that neuropsychological complications emerge from insufficient cerebral perfusion. Relative cerebral hyperperfusion also disrupts cerebral autoregulation and might play a significant role in dNCR development. The aim of this study was to determine the influence of increased a. cerebri media (ACM) blood flow velocity (BFV) during cardiac surgery with cardiopulmonary bypass (CPB) on delayed neurocognitive recovery. Design and Method: This prospective - case control study included patients undergoing elective coronary artery bypass grafting (CABG) or/and valve surgery with CPB. For cognitive evaluation 110 patients completed ACE-III. To determine mild cognitive dysfunction, cut - off 88 was chosen. Mean BFV was monitored with transcranial Doppler ultrasonography (TCD) and performed before surgery and at the beginning, middle and ending of CPB. The average of three CPB measurements was used for calculation. Preoperative BFV was converted to 100% and used as a baseline. The percentage change of cerebral blood flow velocity during CPB was calculated from baseline. Patients with decreased blood flow velocity were included for further investigation. Results: 101 patients were examined, 67 (69,1%) men and 29 (29,9%) women, age 67.9 (SD 9.2) Increased percentage of BFV was determined for 40 (39.60%) patients. Patients’ demographic data are shown in Table 1. Percentage change of BFV was 105.60 % (min 100.21; max 148.02) in the non-dNCR group and 132.29 % (min 101.34; max 150.26) in the dNCR group, p=0.033 (Figure Nr. 1). During the study, we assessed the relationship between patients age and ACE-III test results together with ACM BFV. Spearman correlation analysis revealed that age had negative moderate correlation with ACE-III test results after surgery (Spearman r -0.597, p< 0.01) and negative moderate correlation with ACM BFV during CPB (Sprearman r -0 .529, p <0.01) (Figure 2 and 3). Conclusions: Patients that develop dNCR were significantly older and had a lower baseline BFV. Results suggest that the main cause of hyperperfusion during CPB is age related lower BFV before surgery. Elderly patients are more sensitive to relative hyperperfusion during CPB, therefore dNCR was diagnosed more often in patients with higher percentage change of BFV.

Цель работы – определить влияние факторов риска и изменения скорости кровотока в средней мозговой артерии (СМА) на замедленное восстановление нейрокогнитивных функций (НКФ) у пациентов, перенесших кардиохирургическую операцию с использованием искусственного кровообращения (ИК). Материалы и методы. Проспективное, наблюдательное исследование проводилось в Каунасской клинической больнице Литовского университета наук здоровья («Kaunoklinikos») в Клинике сердечно-торакальной и сосудистой хирургии с 04. 2018 по 04. 2019 г. За день до операции пациенты прошли тест Аденбрука, краткосрочный тест на умственную деятельность и тест соединения точек, а также была проведена транскраниальная допплерография (ТКДГ) для оценки кровотока в средней мозговой артерии (СМА). ТКДГ повторяли после индукции анестезии, в начале, середине и конце ИК. Рассчитывалась средняя скорость кровотока во время ИК. После операции проводилась оценка кровотока в СМА в отделении интенсивной терапии через 4–6 часов после операции. Когнитивные тесты повторялись в течение 7–10 дней после операции.

Background: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. Methods: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher's exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. Results: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). Conclusions: Preoperative assessment to identify obese individuals as being at risk [...].

Background: Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery. Methods: The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bio-ethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient's disagreement. MIME test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery. According to the planned anesthesia, patients were assigned into two groups:[...].

Tyrimo tikslas: Nustatyti rizikos veiksnių ir vidurinės smegenų arterijos kraujo tėkmės greičio pokyčių įtaką uždelstam neuropažintinių funkcijų atsistatymui po širdies operacijų su dirbtine kraujo apytaka (DKA). Rezultatai: Uždelsto neuropažintinių funkcijų atsistatymo dažnis pacientams, kuriems atliktos širdies operacijos DKA sąlygomis yra 40,60 proc. Pooperaciniu laikotarpiu sutrinka atminties, dėmesio, orientacijos, kalbos sklandumo, erdvinio suvokimo ir apdorojimo greičio funkcijos. Pooperaciniu laikotarpiu nustatytos padidėjusios glijos skaidulinio rūgštinio baltymo ir neurofilamentų sunkiosios grandinės koncentracijos kraujyje, tačiau šios koncentracijos nesiskyrė tarp uždelsto ir neuždelsto neuropažintinių funkcijų atsistatymo grupių. Glijos skaidulinis rūgštinis baltymas ir neurofilamentų sunkioji grandinė turi sąsają su delyro išsivystymu. Vidurinės smegenų arterijos kraujo tėkmės greitis mažesnis dirbtinės DKA metu uždelsto neuropažintinių funkcijų atsistatymo grupėje. Veiksniai, susiję su galvos smegenų kraujotaka dirbtinės kraujo apytakos metu: amžius, CO2 ir hematokrito koncentracija. Kiekvieni amžiaus metai didina tikimybę atsirasti uždelstam neuropažintinių funkcijų atsistatymui, o vidurinės smegenų arterijos kraujo tėkmės greičio didėjimas mažina uždelsto neuropažintinių funkcijų sutrikimo atsiradimą. Prastos pažintinės funkcijos prieš operaciją, hemodiliucija ir hiperventiliacija DKA metu turi sąsajas su uždelstu neuropažintinių funkcijų atsistatymu.

Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re‐evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf‐H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non‐dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non‐dNCR group (p < 0.01) and in the dNCR group (p < 0.01), but there was no difference between the groups (after 24 h, p 0.342; after 48 h, p 0.273). Nf‐H increased in both groups (p < 0.01), but there was no difference between them (after 24 h, p = 0.240; after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson’s r 0.40, p < 0.01), hematocrit (r 0.42, p < 0.01), MCA BFV during bypass (r 0.41, p < 0.01), and age (r −0.533, p < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). [...].