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document
Carbon dioxide insufflation in open-chamber cardiac surgery : a double-blind , randomized clinical trial of neurocognitive effects . OBJECTIVE The aims of this study were first to analyze neurocognitive outcomes of patients after open-chamber cardiac surgery to determine whether carbon dioxide pericardial insufflation reduces incidence of neurocognitive decline ( primary end point ) as measured 6 weeks postoperatively and second to assess the utility of carbon dioxide insufflation in cardiac chamber deairing as assessed by transesophageal echocardiography . METHODS A multicenter , prospective , double-blind , randomized , controlled trial compared neurocognitive outcomes in patients undergoing open-chamber ( left-sided ) cardiac surgery who were assigned carbon dioxide insufflation or placebo ( control group ) in addition to standardized mechanical deairing maneuvers . RESULTS One hundred twenty-five patients underwent surgery and were randomly allocated . Neurocognitive testing showed no clinically significant differences in z scores between preoperative and postoperative testing . Linear regression was used to identify factors associated with neurocognitive decline . Factors most strongly associated with neurocognitive decline were hypercholesterolemia , aortic atheroma grade , and coronary artery disease . There was significantly more intracardiac gas noted on intraoperative transesophageal echocardiography in all cardiac chambers ( left atrium , left ventricle , and aorta ) at all measured times ( after crossclamp removal , during weaning from cardiopulmonary bypass , and at declaration of adequate deairing by the anesthetist ) in the control group than in the carbon dioxide group ( P < .04 ) . Deairing time was also significantly longer in the control group ( 12 minutes [ interquartile range , 9-18 ] versus 9 minutes [ interquartile range , 7-14 minutes ] ; P = .002 ) . CONCLUSIONS Carbon dioxide pericardial insufflation in open-chamber cardiac surgery does not affect postoperative neurocognitive decline . The most important factor is atheromatous vascular disease .
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Intervention_Pharmacological
Carbon dioxide insufflation
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Intervention_Pharmacological
carbon dioxide pericardial insufflation
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Intervention_Pharmacological
carbon dioxide insufflation
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Intervention_Pharmacological
carbon dioxide insufflation
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Intervention_Control
placebo
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Intervention_Pharmacological
Carbon dioxide
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Outcome_Mental
neurocognitive outcomes
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Outcome_Mental
neurocognitive decline
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Outcome_Physical
hypercholesterolemia , aortic atheroma grade , and coronary artery disease .
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Outcome_Physical
intracardiac gas
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Outcome_Mental
Deairing time
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Outcome_Mental
neurocognitive decline .
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Participant_Condition
open-chamber cardiac surgery
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Participant_Condition
undergoing open-chamber ( left-sided ) cardiac surgery
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Participant_Sample-size
One hundred twenty-five
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Participant_Condition
atheromatous vascular disease