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CRITICAL CARE AND TRAUMA

Neuronal Injury After Repeated Brief Cardiac Arrests During Internal Cardioverter Defibrillator Implantation Is Associated With Deterioration of Cognitive Function

Manuela Weigl, MD^*, Andrea Moritz, MD^*, Barbara Steinlechner, MD^*, Isabella Schmatzer, cand. med.^*, Bruno Mora, MD^*, Richard Fakin, cand. med.^*, Daniel Zimpfer, MD, Hendrik J. Ankersmit, MD, Cesar Khazen, MD, and Martin Dworschak, MD^*

From the *Department of Anesthesiology and General Intensive Care, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Department of Surgery, Division of Cardiothoracic Surgery, University Hospital Vienna, Austria.

Address correspondence and reprint requests to Martin Dworschak, MD, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, University Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to martin.dworschak{at}meduniwien.ac.at.

To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test and the forward and backward Digit Span tests were used and P300 latencies were determined preoperatively and postoperatively. Serum neuron-specific enolase (NSE) was determined before and at the end of, as well as 2, 6, and 24 h after surgery. Preoperatively, PM patients scored worse in the Digit Span backward and the Trailmaking tests and showed prolonged P300 latencies. Postoperatively, the Digit Span backward scores declined and NSE levels increased only in the ICD group (P 0.05). The difference between preoperative and postoperative Digit Span backward scores correlated with the increase in serum NSE levels (r² = 0.3, P 0.05). Moreover, P300 latencies increased in 13 of 17 ICD patients, but decreased in 7 of 10 PM patients (P 0.05). PM patients even improved in the Trailmaking test (P 0.05). Neuronal injury from even brief periods of global brain ischemia seems to be associated with deteriorating neurocognitive function.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999