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Damage, disruption, delirium

Apr. 20, 2020, 8:00 AM

by Paul Govern

Postoperative delirium occurs in up to 30% of cardiac surgery patients and is associated with longer hospital stays, long-term cognitive decline and increased mortality. Mechanisms underlying postoperative delirium are poorly understood. 

According to an observational study of 400 cardiac surgery patients by Marcos Lopez, MD, MS, Frederic (Josh) Billings IV, MD, MSc, and colleagues, oxidative stress during cardiac surgery is associated with neuronal injury and postoperative delirium.

The study finds that disruption of the blood-brain barrier modifies the association between oxidative damage and neuronal injury and may thus also play a part in the development of postoperative delirium. The study, which appears in  Anesthesiology, hinges on concentrations of various biomarkers in blood samples gathered before, during and after surgery. 

The authors note that previous studies of postoperative delirium have focused on the potential role of anesthetics and sedatives. Their study suggests that treatments that decrease oxidative damage might help with postoperative delirium.

Lopez and Billings were joined by Vanderbilt University Medical Center colleagues Christopher Hughes, MD, Anthony DeMatteo, Jason O’Neal, MD, Brennan McNeil, Matthew Shotwell, PhD, Jennifer Morse, MS, Michael Petracek, MD, Ashish Shah, MD, and Nancy Brown, MD. Funding was provided in part by the National Institutes of Health (GM129662, GM102676, TR000445).

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