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Ann Thorac Surg 1996;61:1295-1296
© 1996 The Society of Thoracic Surgeons

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Editorials

Neurobehavioral Tests Are Monitoring Tools Used to Improve Cardiac Surgery Outcome

Departments of Anesthesia and Cardiothoracic Surgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina

The first 20% of the full text of this article appears below.

The present debate over the best means of analyzing subtle brain dysfunction as a measure of surgical success is a tribute to the advances in cardiopulmonary bypass and cardiac surgery in the past two decades. However, in the coming years, as the results of cardiac surgery come under increasing scrutiny, further vigilance will be necessary to ensure better outcomes.

Major neurologic dysfunction and death have become rare outcomes after cardiopulmonary bypass-rare enough that they provide insufficient statistical power to be useful as timely measures of whether an intervention is of benefit unless a very large, prohibitively expensive, multicenter trial is undertaken. Furthermore, in today's cyberspace environment, patients expect not only to survive their operation but to be at least as functional as they were before their intervention. To fulfill this expectation, new definitions of what exactly constitutes a positive outcome are required.

See also 1342.

What Are Neurobehavioral Tests?

Psychological tests are not just IQ tests or questionnaires about your childhood. They are also short, easy to administer, objective, and sensitive means of assessing the alterations in brain function associated with cardiopulmonary bypass [1]. They provide an attractive, practical alternative to morbidity and mortality statistics. A reliable ``brain function test'' allows the evaluation of surgical and pharmacologic interventions with relatively small numbers of patients. Tests of fine motor function, verbal and nonverbal memory, attention, and concentration are collectively referred to as ``neuropsychological tests'' and are designed as tools to assess the most complex structure on earth, the human brain. ``Neurobehavioral'' is a more inclusive term that includes aspects of neurologic and neuroophthalmologic assessment.

One example of the utility of neuropsychological tests is their routine serial administration to National Football League quarterbacks to assess the cumulative effects of concussion. They are the determining . . . [Full Text of this Article]

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