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 bioethics 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. MMSE 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: 1 – combined general + epidural anesthesia and 2 – general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded. Results: Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment (P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).

Background and Objectives: Cardiac surgery is associated with various durations of cerebral autoregulation (CA) impairment and can significantly impact cognitive function. Cognitive functions such as memory, psychomotor speed, and attention are significantly impacted after cardiac surgery, necessitating prioritization of these areas in cognitive function tests. There is a lack of research connecting cerebral autoregulation impairment to specific cognitive function domains after cardiac surgery. This study aimed to determine if impaired cerebral autoregulation is associated with postoperative memory impairment and to test the hypothesis that the duration of this impairment affects the development of postoperative memory issues. Materials and Methods: A prospective study was conducted in 2021–2023. After approval of the Ethics Committee and with patient’s written consent, 83 adult patients undergoing elective on-pump coronary artery bypass graft (CABG) surgery were enrolled. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination (MMSE-2) test as a screening tool and the Hopkins Verbal Learning Test-Revised (HVLT-R) to assess memory specifically. To diagnose possible memory impairment (IM), all patients underwent a repeat assessment of cognitive function on the 7th–10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. Cerebral autoregulation status index (Mx) was recorded using Intensive Care Brain Monitoring System software, 9.1.5.23 (Cambridge, UK). Results: According to our research, the incidence of postoperative memory impairment is 30.1%. Temporary cerebral autoregulation impairment occurs in all patients undergoing elective in-pump CABG surgery. The duration of the single longest CA impairment event in seconds (LCAI) and the LCAI dose were higher in patients with postoperative memory impairment, p = 0.006 and p < 0.007, respectively. Conclusions: Cerebral autoregulation impairment is important in developing memory loss after cardiac surgery. The duration and dose of the LCAI event are predictive of postoperative memory impairment.

Background and Objectives: Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. However, postoperative cognitive decline (POCD) remains a significant concern, affecting a substantial proportion of patients. One of the pathogenic mechanisms underlying POCD involves inflammatory responses and oxidative stress. Dexamethasone, a corticosteroid with potent anti-inflammatory properties, has been proposed as a potential neuroprotective agent. This study aimed to assess the effect of a single perioperative dose of dexamethasone on postoperative cognitive function in patients undergoing CABG surgery. Materials and Methods: This retrospective cohort study was conducted at the Hospital of Lithuania. Inclusion criteria: elective CABG surgery, non-neurocognitive anamnesis, Minimal Mental State Examination score ≥25 before surgery, and age >50. Patients were divided into two groups: DEXA (those who received preoperative dexamethasone 0.1 mg/kg) and non-DEXA (those who did not). Cognitive functions were assessed with the Addenbrooke’s Cognitive Examination test (ACE-III) 7 days post operation. Results: The study enrolled 60 patients (DEXA = 30, non-DEXA = 30): male (85%), female (15%). The mean age of the study was 66.1 ± 8.1 and the education was 12 (12–30) years. The groups were similar in the evaluated preoperative characteristics (sex, age, education) (p > 0.05). Cognitive impairment (ACE-III score cut–off 88 points) was identified in 40% (n = 12) of participants in the DEXA and 69.3% (n = 21) in the non-DEXA group, with no statistically significant difference between groups (p = 0.073). However, the DEXA group had significantly better cognitive scores in attention (Z = 3.145, p = 0.002), fluency (Z = 2.25, p = 0.024), and spatial ability (Z = 4.444, p < 0.001) while language (Z = 1.167, p = 0.243) and memory scores (Z = 1.906, p = 0.057) showed no significant differences. Conclusions: These findings suggest that dexamethasone may provide neuroprotective benefit, reducing postoperative cognitive function domains, such as attention, fluency, and spatial ability, after CABG surgery. Further prospective studies are needed to confirm these findings.

Introduction: Postoperative delirium affects up to 60% of cardiac surgical patients. No reliable gold standard method exists for preventing delirium after cardiac surgery. An example of patient-personal monitoring is cerebral autoregulation (CA). This study aims to highlight the personal monitoring of patients’ cerebral autoregulation and to determine its relationship with postoperative delirium. Additionally, it seeks to test the hypothesis that the duration of CA impairment influences the onset of postoperative delirium. Methods: A prospective study was conducted in 2021–2023. After approval of the Ethics Committee and with the patient’s written consent, 104 adult patients undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) surgery were enrolled. To diagnose possible delirium, all patients underwent a Confusion Assessment Method for the Intensive Care Unit (CAM–ICU) test. CA monitoring using transcranial Doppler was performed. CA status index – Mx was recorded. Results: Our study found that 12.5% of patients were diagnosed with delirium after on-pump CABG surgery. The total duration of cerebral autoregulation impairment (TCAI) was longer in the delirium group, 4783.0 seconds versus 4204.5 seconds ( p = .047), with a cut-off at 4380 s. Longer cardiopulmonary bypass (CPB) leads to prolonged CA impairment ( p < .001). The mean arterial pressure (MAP) during CPB was 69.67 mmHg in the non-delirium group and 74.91 mmHg in the delirium group ( p = .001), with a cutoff at 73.669 mmHg. Conclusions: CA impairment is crucial for delirium development after cardiac surgery. The duration of the TCAI event increases the risk of delirium.

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 (r_s = 0.243, p = 0.003) and with perioperative increases from baseline to ICU admission (ΔS4-1: r_s = 0.196, p = 0.017) and from aortic clamping to ICU admission (ΔS4-2: r_s = 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.