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D L Baird

Publications and source records attributed to D L Baird.

3 recordsLinked to original sources
PubMed1997

Neurologic findings in coronary artery bypass patients: perioperative or preexisting?

OBJECTIVES/DESIGN: This prospective study compares the incidence of preexisting neurologic findings in elective cardiac surgery patients presenting with and without coronary atherosclerosis. SETTING: This single-center study was conducted at a tertiary care hospital. PARTICIPANTS/INTERVENTIONS: After Review Board approval and obtaining written informed consent, 11 patients undergoing valvular heart surgery, 9 patients undergoing similar valvular procedures with concomitant coronary artery bypass surgery, and 4 patients undergoing coronary artery bypass surgery alone were enrolled. Preoperatively, all patients underwent a structured neurologic assessment, and the latter four additionally had preoperative magnetic resonance imaging. MEASUREMENTS AND MAIN RESULTS: The patients, 9 of 24 of whom were female, were aged 46 to 78 years and, other than ischemic heart disease, had medical histories that were similar between groups, with the exception of one patient having scleroderma. None of the patients had a clinical history of neurologic or cerebrovascular disease. Nine percent (1 of 11) of the valve-only patients showed subtle preoperative neurologic abnormalities, compared with 89% (eight of nine) of the valve patients having concomitant coronary surgery and 100% (four of four) of coronary artery bypass-only patients. Additionally, brain imaging scans of all four coronary bypass patients showed nonspecific changes reported as scattered punctate areas of high signal less than 3 to 4 mm in diameter. CONCLUSION: This survey shows that both subtle neurological abnormalities and magnetic resonance imaging lesions can be found in a high percentage of patients with coronary atherosclerosis. Furthermore, this study indicates that without a standardized preoperative neurological examination, postoperative neurologic dysfunction cannot necessarily be ascribed to perioperative events.

Aged↗
PubMed1997

Cognitive dysfunction after ventricular fibrillation during implantable cardiovertor/defibrillator procedures is related to duration of the reperfusion interval.

The insertion of implantable cardioverter/defibrillators (ICD) requires induction of repeated episodes of ventricular fibrillation (VF). The neuropsychological repercussions associated with repeated inducement of hypotension and cerebral ischemia are unknown. In this prospective clinical trial, 1 day prior to ICD assessment/implantation and 5 days postprocedure, 14 patients underwent neurological and cognitive screening. Cognitive dysfunction was defined as impaired performance in one of four cognitive domains. Neurological impairment was defined as a decrement of 2 or more points from baseline of a total possible score of 45 points. Intraoperative hemodynamics, including the reperfusion interval (RI; end of preceding fibrillation to beginning of the next), were recorded. Patients underwent an average of 12 +/- 6 episodes of VF with average duration of mean arterial pressure (MAP) <50 mm Hg for 17 +/- 9 s (range 6-39 s) and of MAP <30 mm Hg for 11 +/- 5 s (range 2-22 s). Nine patients, in none of whom the predetermined criteria for neurologic impairment was met, demonstrated a new subtle neurologic finding postoperatively. Ten of 14 patients met the criterion for cognitive dysfunction 5 days postoperatively. The mean RI between episodes of VF was significantly different between those patients demonstrating cognitive dysfunction and the unimpaired patients (3.1 +/- 0.5 min in the group with cognitive dysfunction vs 3.9 +/- 0.8 min in the unimpaired group, P = 0.027). Five patients without cognitive impairment had longer RI between episodes of circulatory arrest than those showing impaired cognition. We conclude that cognitive dysfunction can occur after insertion of ICD and is related to the duration of RI.

Adult↗