title: Electroencephalographic changes after pediatric cardiac surgery with cardiopulmonary bypass: is slow wave activity unfavorable?
abstract: Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with neurologic deficits. We describe the postoperative EEG changes, assess their possible causes, and evaluate their relevance to neurologic outcome. Thirty-one children and five neonates with congenital heart disease were included. EEG recording started after intubation and continued until 22-96 h after CPB. In addition to conventional analysis, spectral analysis was performed for occipital and frontal electrodes, and differences between pre- and postoperative delta power (delta-deltaP) were calculated. Maximum values of occipital delta-deltaP that occurred within 48 h after CPB were correlated with clinical variables and with perioperative markers of oxidative stress and inflammation. Occipital delta-deltaP correlated with frontal delta-deltaP, and maximum delta-deltaP correlated with conventional rating. Distinct rise of deltaP was detected in 18 of 21 children without any acute or long-term neurologic deficits but only in five of 10 children with temporary or permanent neurologic deficits. Furthermore, maximally registered delta-deltaP was inversely associated with duration of CPB and postoperative ventilation. Maximal delta-deltaP was also inversely associated with the loss of plasma ascorbate (as an index of oxidative stress) and plasma levels of IL-6 and IL-8. Slow wave activity frequently occurs within 48 h after CPB. However, our data do not support the notion that EEG slowing is associated with adverse neurologic outcome. This is supported by the fact that EEG slowing was associated with less oxido-inflammatory stress.
authors.affiliation: University Children's Hospital, Zürich, Switzerland. benhard.schmitt@kispi.unizh.ch
authors.forename: Bernard
authors.initials: B
authors.lastname: Schmitt
authors.forename: Barbara
authors.initials: B
authors.lastname: Finckh
authors.forename: Stephan
authors.initials: S
authors.lastname: Christen
authors.forename: Jens
authors.initials: J
authors.lastname: Lykkesfeldt
authors.forename: Edith R
authors.initials: ER
authors.lastname: Schmid
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: Hanne
authors.initials: H
authors.lastname: Critelli
authors.forename: Bea Latal
authors.initials: BL
authors.lastname: Hajnal
authors.forename: Peter
authors.initials: P
authors.lastname: Gessler
authors.forename: Luciano
authors.initials: L
authors.lastname: Molinari
mesh_terms: D001205:Ascorbic Acid / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009474:Neurons / Q000378:metabolism; D018384:Oxidative Stress; D011184:Postoperative Period; D013997:Time Factors
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8; D001205:Ascorbic Acid