Neurocognitive Dysfunction and Delirium

Neurological complications represent the main risk of morbidity and mortality after cardiac surgery. Cardiopulmonary bypass was considered for a long time as the major cause of such problems. However, modern surgical techniques have not reduced the prevalence of postoperative brain disorders. Patient-specific characteristics are probably more important determinants than the type of surgery itself. Postoperative neurological injuries are classified into four categories: (1) focal lesions (stroke) responsible for severe cerebral damage (2) reversible neurocognitive dysfunction without any focal deficit; (3) seizures and (4) delirium. Prevention strategies based on statins or aspirin during the preoperative period may yield some benefits. Surgeons are advised to use epiaortic ultrasound prior to aortic cannulation as an effective mean to reduce type 1 complications. Anesthesiologists have to monitor global and regional perfusion indices to try to minimize potential cerebral suffering during surgery. Finally, in case of neurological injury, the use of appropriate neuroimaging techniques to guide diagnosis and early intervention when indicated, management of postoperative medications combined with early rehabilitation represents the best recommended strategy.