Department of Cardiothoracic Surgery, Dubai Hospital, Dubai, UAE
Online published on 4 July, 2017.
The use of cardiopulmonary bypass has helped in the evolution of cardiac surgery. The advances in equipment, innovations in extracorporeal circulation, have contributed in their own unique ways to development of innovative surgical techniques which have led to treating complex congenital cardiac disorders, once considered as “inoperable”.
One of the key areas of concern while employing cardiopulmonary bypass is the neurological outcome of the patient. The complex factors inherent in the employment of extracorporeal circulation are known to create neurological deficit if not monitored. Unphysiological conditions of flow, the fluctuations of temperature (employment of hypothermia and subsequent rewarming) and the effects of extracorporeal circulation can lead to neurological deficit, especially in neonatal cardiopulmonary bypass wherein extracorporeal circulation is ‘stretched to its limits’.
The article presents the importance of neuromonitoring in neonatal CPB; the current techniques employed in neuromonitoring such as Jugular Venous Bulb Oxygen Saturation (SjvO2), Near Infra Red Spectroscopy (NIRS), Bi-Spectral Index (BIS), Transcranial Doppler Ultrasonography (TCDS), are put to scrutiny and the article concludes with a note on biochemical markers of neurological injury, such as S100B, HSP 70, Neuron Specific Enolase and Glial Fibrillary Acidic Protein
