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Ann Thorac Surg 1996;61:1423-1427
© 1996 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Cardiopulmonary Bypass, Rewarming, and Central Nervous System Dysfunction

Department of Anaesthesia, Clinical Epidemiology Unit and Department of Medicine, Department of Psychology, Division of Neurology, Department of Medicine, and Division of Cardiovascular Surgery, Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada

Accepted for publication February 3, 1996.

Background. During cardiopulmonary bypass a nasopharyngeal temperature greater than 38°C at the end of rewarming may indicate cerebral hyperthermia. This could exacerbate an ischemic brain injury incurred during cardiopulmonary bypass.

Methods. In a cohort of 150 aortocoronary bypass patients neuropsychologic test scores of 66 patients whose rewarming temperature exceeded 38°C were compared with those who did not. There were no differences between groups with respect to demographic and intraoperative variables.

Results. A trend was seen for hyperthermic patients to do worse on all neuropsychologic tests in the early postoperative period but not at 3-month follow-up. By analysis of covariance hyperthermic patients did worse on the visual reproduction subtest of the Weschler memory scale at 3 months (p = 0.02), but this difference was not found by linear regression (p = 0.10).

Conclusions. We were unable to demonstrate any significant deterioration in patients rewarmed to greater than 38°C in the early postoperative period. The poorer performance in the visual reproduction subtest of the Wechsler memory scale at 3 months in the group rewarmed to more than 38°C is interesting but far from conclusive. Caution with rewarming is still advised pending more in-depth study of this issue.

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