Neurologic dysfunction in cardiac surgery

Neurologic dysfunction in cardiac surgical patients continues to be a devas tating complication. Advances in myocardial preservation and improved cardi ac results have highlighted the extent that neurologic dysfunction contribu tes to the adverse outcome of patients undergoing cardiac surgery. Frank st roke occurs in 2% to 5% of cardiac surgical patients, while thorough neurol ogic testing reveals a 30% to 80% postoperative incidence of neurocognitive dysfunction. This article examines etiologies responsible for this morbidi ty and strategies that may minimize this complication. These include: surgi cal variations to aortic clamping management of mean arterial pressure, tem perature, glucose, acid-base status, and hemoglobin during cardiopulmonary bypass. The prospects and goals of pharmacologic neuroprotection are discus sed.