Intraoperative Cortical Asynchrony Predicts Abnormal Postoperative Electroencephalogram.

Autor:	Swartz MF; Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address: michael_swartz@urmc.rochester.edu., Seltzer LE; Department of Neurology, University of Rochester Medical Center, Rochester, New York., Cholette JM; Department of Pediatrics, University of Rochester Medical Center, Rochester, New York., Yoshitake S; Department of Surgery, University of Rochester Medical Center, Rochester, New York., Darrow N; Department of Surgery, University of Rochester Medical Center, Rochester, New York., Algahim MF; Department of Surgery, University of Rochester Medical Center, Rochester, New York., Alfieris GM; Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2021 Feb; Vol. 111 (2), pp. 645-654. Date of Electronic Publication: 2020 Jun 06.
DOI:	10.1016/j.athoracsur.2020.04.090
Abstrakt:	Background: Postoperative electroencephalograms (EEGs) can identify seizure activity and neurologic dysfunction in high-risk neonates requiring cardiac surgical procedures. Although intraoperative EEG monitoring is uncommon, variations in cerebral blood flow and temperature during antegrade cerebral perfusion (ACP) can manifest as cortical asynchrony during EEG monitoring. We hypothesized that intraoperative EEG cortical asynchrony would identify neonates at risk for abnormal postoperative EEG tracings. Methods: Neonates requiring ACP for cardiac repair or palliation had continuous baseline, intraoperative, and postoperative hemodynamic and EEG monitoring. Synchronous and asynchronous cortical bursts were quantified during (1) cooling before ACP, (2) ACP, and (3) rewarming. Asynchronous bursts were defined as interhemispheric variations in electrical voltage or frequency. Neonates were divided into 2 groups, those with and without an abnormal postoperative EEG, which was defined as either persistent asynchrony for more than 2 hours or seizure activity on EEG. Results: Among 40 neonates, 296 asynchronous bursts were noted, most commonly during rewarming. Eight (20%) neonates had an abnormal postoperative EEG (seizure activity, n = 3; persistent asynchrony, n = 5). Baseline demographics and intraoperative hemodynamics were similar between the groups. However, the total number of intraoperative asynchronous bursts was greater in neonates with an abnormal postoperative EEG (17 [11, IQR:24] vs 3 [IQR:1, 7]; P < .001). Multivariate analysis confirmed that the number of asynchronous bursts was independently associated with an abnormal postoperative EEG (odds ratio,1.35; confidence interval,:1.10, 1.65; P = .004). Conclusions: Neonates with a greater number of intraoperative asynchronous cortical bursts had an abnormal postoperative EEG. (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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