Glutamate/Aspartate Supplementation during Cardiopulmonary Bypass: Effect on Postoperative Neurocognitive Function
DOI:
https://doi.org/10.1532/HSF98.20071169Abstract
In this randomized trial, we investigated the effect of glutamate/aspartate-containing cardioplegia on neurocognitive function in 70 patients undergoing first-time elective coronary artery bypass graft surgery. Half of the patients received glutamate/aspartate, and the other 35 patients served as controls and received crystalloid cardioplegia. Neurocognitive function after surgery was assessed with the Mini-Mental State Examination performed before surgery and again on postoperative day 3. Although patients in both groups scored slightly lower postoperatively (17 versus 18 of a total of 30 points), no significant group differences were found. Our results indicate that glutamate/aspartate supplementation had no impact on neurocognitive function after coronary artery bypass graft surgery.References
Arrowsmith JE, Harrison MJG, Newman SP, et al. 1998. Neuroprotection of the brain during cardiopulmonary bypass: a randomized trial of remacemide during coronary artery bypass in 171 patients. Stroke 29:2357-5.nBach-y-Rita P. 2002. Volume transmission and brain plasticity. Evolution Cognition 8:115-7.nBhudia SK, Cosgrove DM, Naugle RI, et al. 2006. Magnesium as a neuroprotectant in cardiac surgery: A randomized clinical trial. J Thorac Cardiovasc Surg 131:853-8.nBronster DJ. 2006 Neurologic complications of cardiac surgery: current concepts and recent advances. Curr Cardiol Rep 8:9-7.nBrowne SM, Halligan PW, Wade DT, et al. 1999. Cognitive performance after cardiac operation: implications of regression toward the mean. J Thorac Cardiovasc Surg 117:481-4.nBruno V, Copani A, Knopfel T, et al. 1995. Activation of metabotropic glutamate receptors coupled to inositol phospholipid hydrolysis amplifies NMDA-induced neuronal degeneration in cultured cortical cells. Neuropharmacology 34:1089-9.nBurker EJ, Blumenthal JA, Feldman M, et al. 1995. The Mini Mental State Exam as a predictor of neuropsychological functioning after cardiac surgery. Int J Psychiatry Med 25:263-13.nButterworth J, Hammon JW. 2002. Lidocaine for neuroprotection: more evidence of efficacy. Anesth Analg 95:1131-2.nGladstone DJ, Black SE, Hakim AM. 2002. Toward wisdom from failure: lessons from neuroprotective stroke trials and new therapeutic directions. Stroke 33:2123-3nHindman BJ, Todd MM. 1999. Improving neurologic outcome after cardiac surgery. Anesthesiology 90:1243-4.nKing N, McGivan JD, Griffiths EJ, et al. 2003. Glutamate loading protects freshly isolated and perfused adult cardiomyocytes against intracellular ROS generation. J Mol Cell Cardiol 35:975-9.nLewis MS, Maruff PT, Silbert BS. 2005. Examination of the use of cognitive domains in postoperative cognitive dysfunction after coronary artery bypass graft. Ann Thorac Surg 80:910-6.nNagels W, Demeyere R, Hemelrijck JV, et al. 2004. Evaluation of the neuroprotective effects of S(+)-ketamine during open-heart surgery. Anesth Analg 98:1595-8.nNewman MF, Croughwell ND, Blumenthal JA, et al. 1996. Cardiopulmonary bypass and the central nervous system: potential for cerebral protection. J Clin Anesth 8(3 Suppl):53-7.nNewman S. 1995. Analysis and interpretation of neuropsychologic tests in cardiac surgery. Ann Thorac Surg 59:1351-4.nOzyurt E, Graham DI, Woodruff GN. 1988. Protective effect of the glutamate antagonist MK801 in focal cerebral ischaemia in the cat. J Cereb Blood Flow Metab 8:138-5.nPugsley W, Klinger L, Paschalis, et al. 1994. The impact of microemboli in cardiopulmonary bypass on neuropsychological functioning. Stroke 25:1393-6.nSmith HC, Hacke W, Hennerici M, et al. 1996. Lubeluzole in acute ischaemic stroke. Stroke 27:76-5.nSmith P, Treasure T, Newman S, et al. 1986. Cerebral consequences of cardiopulmonary bypass. Lancet 1:823-2.nSmith QR. 2000. Transport of glutamate and other amino acids at the blood-brain barrier. J Nutr 130:1016-6.nStump D. 1995. Selection and clinical significance of neuropsychologic tests. Ann Thorac Surg 59:1340-4.nVizi ES. 2000. Role of high-affinity receptors and membrane transporters in nonsynaptic communication and drug action in central nervous system. Pharmacol Rev 52:63-27.nWeissrock S, Levy F, Balabaud V, et al. 2005. Interest of the Mini Mental State Examination to detect cognitive defects after cardiac surgery. Ann Fr Anesth Reanim 24(10):1255-6.n
