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Changes in the psychsocial status after cardiac surgery in a 10-years follow-up study
S73
POSTER PRESENTATIONS
II, cardiopulmonary bypass time, as well as BNP and TNT on postoperative day 1, continued to show a hazard ratio (HR) of 0.39 (95%CI 0.20 – 0.76) for increasing delta BNP. Stratification of BNP values on the first postop. day above and below 682 ng/L revealed increased mortality in the high BNP group (4682ng/L) for increasing delta BNP (log-rank p¼0.010), but decreased mortality in the low BNP group (o682ng/L) for increasing delta BNP (logrank p ¼0.001), albeit with a low event rate (21). Discussion. This preliminary analysis suggests that routine serial BNP measurements may be difficult to interpret. However, for patients with initially high postoperative BNP, a second measurement may contain additional prognostic information P-23 Changes in the psychsocial status after cardiac surgery in a 10-years follow-up study Enikő Holndonner-Kirst1, Lili Varga2, Andrea Szekely1 1
Semmelweis University, Dept of Anaesthesiology and Intensive Therapy, 2Semmelweis University
Background & Aim. Since the mortality after cardiac surgery has radically decreased in the last decades, the researchers take much interest in the postoperative psychosocial status and quality of life. On the other hand, psychosocial factors have been identified as risk factors for adverse long-time outcome after cardiac procedures. Methods. 180 patients, having undergone elective coronary artery bypass graft or valve surgery in Gottsegen György Hungarian Institute of Cardiology between July 2000 and May 2001, were enrolled in our prospective study. Anamnestic medical and psychosocial factors, a wide range of intra- and postoperative clinical factors and complications were recorded. The Beck depression inventory (BDI), state and trait anxiety subscale in Spielberger State–Trait Anxiety Inventory (STAI-S, -T) tests were recorded preoperatively, half, one, two, three, four, five, seven and ten years postoperatively. The social support, negative affectivity (NA), social inhibition (SI) tests were sent in the postoperative second, fifth, seventh and tenth year. Medical status and hospitalisation history were also asked at each interview. We used all-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) as clinical end-points. Results. Age, the value of preoperative risk assessment scores, length of postoperative ICU stay and early complications, preoperative STAI-T, STAI-S, BDI as well as mean postoperative SI, STAI-T and BDI scores had significant adverse effect on both endpoints, while educational level were significantly protective in both. In a multivariable model with Euroscore the reoperation, circulatory failure were significant risk factors for both, while educational level was found to be protective for survival. Significant elevation was observed in STAI-S, STAI-T, BDI, NA, SI during the follow-up, but it was independent from the occurrence of MACCE. Conclusion. Psychosocial factors have a significant impact on survival and occurrence of MACCE after cardiac surgery, while higher educational level might be protective factor. P-24 The influence of dexmedetomidine on the quantity of postoperative cognitive disorders after cardiac surgery Piotr Jakubow Cardiosurgery Department
Background & Aim. Despite the progress of technology, the cognitive dysfunction and delirium in the postoperative period after cardiac operations still exist.(1,3) Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, revealed anesthesia and a brain protective role.(2) Methods. The study evaluated a group of 150 patients staying in the postoperative department after different cardiac surgery operations. Patients were divided into 5 groups in terms of different kinds of sedative drug used and its connection to opioid drugs. Patients were assessed a battery of cognitive tests a week before and within 10 days, after surgery, in some patients a lab study S-100, NSE, BDNF was performed. In the course of sedation, handling and recovery from the infusion of the drug were assessed by the nursing staff. Results. In the study group, the total quantity of cognitive disorders, including delirium within 10 days after the operation, has occurred in 12% of propofol group, 10.6% in the midanium and 9.7% in the Dexmedetomidine group. Steering sedation was best assessed in a group of Propofol, but in this group there was the most unexpected reaction to the stimulation after discontinuation of the infusion. The amount of uncontrolled psychomotor agitation after the end of sedation was the smallest in the group of Sufentanil and Midanium or Dexmedetomidine. In the study, neuropsychological tests in Dexmedetomidine and Sufentanil group showed better results in the long-term memory in a recall subtest. Conclusion. The application of Dexmedetomidine does not adversely affect cognitive function observed in the postoperative period. This is probably a protective effect of hippocampal neuronal inflammatory response. REFERENCES 1. Monk TG: Postoperative cognitive disorders. Curr Opin Crit Care. 4:376-378, 2011. 2. Qian,Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol. 746:206-212, 2015. 3. Krzych LJ: Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis. J Cardiothorac Vasc Anesth. 28(3):448-457, 2014. P-25 Leipzig-Basel experiences with EACTA fellowship program V. Protsyk1, J. Fassl2, M. Maurer2 J. Ender1 1 Department of Anaesthesiology and Intensive Care Medicine, Heartcentre, University Leipzig, Germany, 2Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Switzerland
Introduction. Since 2009 some European centres offer EACTAaccredited 2-year Fellowship program in cardiothoracic and vascular anaesthesia. To ensure a high quality in the education of the fellows we evaluated the workload of each fellow in two centres: University Hospital Basel (USB), Switzerland and Heartcenter University Leipzig (HCL), Germany. Methods. In this retrospective study the numbers of anaesthesia, where each fellow was involved, the numbers of performed transoesophageal ultrasound examinations (TEE) and the completion of the EACVI examination/certification were evaluated based on the individual database in each centre.
POSTER PRESENTATIONS
II, cardiopulmonary bypass time, as well as BNP and TNT on postoperative day 1, continued to show a hazard ratio (HR) of 0.39 (95%CI 0.20 – 0.76) for increasing delta BNP. Stratification of BNP values on the first postop. day above and below 682 ng/L revealed increased mortality in the high BNP group (4682ng/L) for increasing delta BNP (log-rank p¼0.010), but decreased mortality in the low BNP group (o682ng/L) for increasing delta BNP (logrank p ¼0.001), albeit with a low event rate (21). Discussion. This preliminary analysis suggests that routine serial BNP measurements may be difficult to interpret. However, for patients with initially high postoperative BNP, a second measurement may contain additional prognostic information P-23 Changes in the psychsocial status after cardiac surgery in a 10-years follow-up study Enikő Holndonner-Kirst1, Lili Varga2, Andrea Szekely1 1
Semmelweis University, Dept of Anaesthesiology and Intensive Therapy, 2Semmelweis University
Background & Aim. Since the mortality after cardiac surgery has radically decreased in the last decades, the researchers take much interest in the postoperative psychosocial status and quality of life. On the other hand, psychosocial factors have been identified as risk factors for adverse long-time outcome after cardiac procedures. Methods. 180 patients, having undergone elective coronary artery bypass graft or valve surgery in Gottsegen György Hungarian Institute of Cardiology between July 2000 and May 2001, were enrolled in our prospective study. Anamnestic medical and psychosocial factors, a wide range of intra- and postoperative clinical factors and complications were recorded. The Beck depression inventory (BDI), state and trait anxiety subscale in Spielberger State–Trait Anxiety Inventory (STAI-S, -T) tests were recorded preoperatively, half, one, two, three, four, five, seven and ten years postoperatively. The social support, negative affectivity (NA), social inhibition (SI) tests were sent in the postoperative second, fifth, seventh and tenth year. Medical status and hospitalisation history were also asked at each interview. We used all-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) as clinical end-points. Results. Age, the value of preoperative risk assessment scores, length of postoperative ICU stay and early complications, preoperative STAI-T, STAI-S, BDI as well as mean postoperative SI, STAI-T and BDI scores had significant adverse effect on both endpoints, while educational level were significantly protective in both. In a multivariable model with Euroscore the reoperation, circulatory failure were significant risk factors for both, while educational level was found to be protective for survival. Significant elevation was observed in STAI-S, STAI-T, BDI, NA, SI during the follow-up, but it was independent from the occurrence of MACCE. Conclusion. Psychosocial factors have a significant impact on survival and occurrence of MACCE after cardiac surgery, while higher educational level might be protective factor. P-24 The influence of dexmedetomidine on the quantity of postoperative cognitive disorders after cardiac surgery Piotr Jakubow Cardiosurgery Department
Background & Aim. Despite the progress of technology, the cognitive dysfunction and delirium in the postoperative period after cardiac operations still exist.(1,3) Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, revealed anesthesia and a brain protective role.(2) Methods. The study evaluated a group of 150 patients staying in the postoperative department after different cardiac surgery operations. Patients were divided into 5 groups in terms of different kinds of sedative drug used and its connection to opioid drugs. Patients were assessed a battery of cognitive tests a week before and within 10 days, after surgery, in some patients a lab study S-100, NSE, BDNF was performed. In the course of sedation, handling and recovery from the infusion of the drug were assessed by the nursing staff. Results. In the study group, the total quantity of cognitive disorders, including delirium within 10 days after the operation, has occurred in 12% of propofol group, 10.6% in the midanium and 9.7% in the Dexmedetomidine group. Steering sedation was best assessed in a group of Propofol, but in this group there was the most unexpected reaction to the stimulation after discontinuation of the infusion. The amount of uncontrolled psychomotor agitation after the end of sedation was the smallest in the group of Sufentanil and Midanium or Dexmedetomidine. In the study, neuropsychological tests in Dexmedetomidine and Sufentanil group showed better results in the long-term memory in a recall subtest. Conclusion. The application of Dexmedetomidine does not adversely affect cognitive function observed in the postoperative period. This is probably a protective effect of hippocampal neuronal inflammatory response. REFERENCES 1. Monk TG: Postoperative cognitive disorders. Curr Opin Crit Care. 4:376-378, 2011. 2. Qian,Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol. 746:206-212, 2015. 3. Krzych LJ: Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis. J Cardiothorac Vasc Anesth. 28(3):448-457, 2014. P-25 Leipzig-Basel experiences with EACTA fellowship program V. Protsyk1, J. Fassl2, M. Maurer2 J. Ender1 1 Department of Anaesthesiology and Intensive Care Medicine, Heartcentre, University Leipzig, Germany, 2Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Switzerland
Introduction. Since 2009 some European centres offer EACTAaccredited 2-year Fellowship program in cardiothoracic and vascular anaesthesia. To ensure a high quality in the education of the fellows we evaluated the workload of each fellow in two centres: University Hospital Basel (USB), Switzerland and Heartcenter University Leipzig (HCL), Germany. Methods. In this retrospective study the numbers of anaesthesia, where each fellow was involved, the numbers of performed transoesophageal ultrasound examinations (TEE) and the completion of the EACVI examination/certification were evaluated based on the individual database in each centre.