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Additional info for Perioperative Considerations in Cardiac Surgery
The beneficial effects of hypothermia mainly depend on the two physiologic principles, functional and structural cerebral metabolic need for oxygen that are both reduced by temperature; total cerebral metabolic rate of oxygen (CMRo2) decreases 6-7 % per degree Centigrade reduction; while anesthetic drugs alter only functional CMRo2 (Grigore et al,2009). Thiopental in particular, reduces cerebral metabolic rate required by brain function and synaptic activity, which are achieved during the isoelectric electroencephalographic state.
Moderate (28 C) and mild hypothermia (32-34 C) was shown to have no difference in terms of cognitive dysfunction, however hyperthermia (especially if the gradient between the temperatures of nasopharyngeal and CPB perfusate is >2C) in the perioperative and postoperative period is clearly associated with neurocognitive decline Anesthesia in Cardiac Surgery 31 (Klementavicius et al,1996). Any potential benefit for cerebral protection of hypothermia can be offset by inappropriate rewarming. More important than the use of hypothermia is avoidance of hyperthermia (Grigore et al,2009).
In patients who stays more than 5 days in ICU, aggressive glycemic control was clearly proven to reduce mortality (Van den Berghe et al,2001). Similarly, in a retrospective analysis of cardiac surgical patients a predetermined glucose level (<150 mg/dl) was targeted with a continuous insulin infusion for 3 days postoperatively, had reduced risks of death and deep 32 Perioperative Considerations in Cardiac Surgery sternal wound infections (Furnary et al, 2004). There are conflicting results about the association between hyperglycemia and adverse neurological outcome, and yet whether the glycemic control improves neurological outcome is not clear.