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Ann Thorac Surg 1999;67:1124
© 1999 The Society of Thoracic Surgeons

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Invited Commentary

^a Section on Cardiothoracic Anesthesia, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1009, USA

Invited commentary

Neuropsychologic deficits remain vexing complications after both coronary artery and valve operations. Studying patients undergoing aortic or mitral valve operation, Mitchell and colleagues found that a relatively simple and low-risk intervention, prophylactic infusion of lidocaine, substantially improved neuropsychologic outcome at 10 days, 10 weeks, and 6 months compared to a placebo control. The treatment group had an improved outcome, despite its including significantly more patients having concurrent coronary artery bypass grafting. One might have assumed that coronary artery disease would associate with an increased risk of aortic atheromata and cerebral embolism atttributable to clamping and unclamping, and with a worsened neuropsychologic outcome.

Should all patients undergoing valve procedures now receive prophylactic lidocaine? The reduced deficit rate with lidocaine, although promising, does not achieve statistical significance if a "deficit" is defined by decrements in two or more neuropsychologic assessment scales. (This "two or more" standard has been used in several other neuropsychologic outcome studies [1–3].) Thus, it would seem reasonable to delay incorporating routine, prophylactic lidocaine infusion in the Care Map (The Center for Case Management, South Natick, MA) of all patients having cardiac operation with cardiopulmonary bypass until additional patients have been studied.

References

1. Heyer E.J., Delphin E., Adams D.C., et al. Cerebral dysfunction after cardiac operations in elderly patients. Ann Thorac Surg 1995;60:1716-1722.[Abstract/Free Full Text]
2. Vingerhoets G., Van Nooten G., Vermassen F., De Soete G., Jannes C. Short-term and long term neuropsychological consequences of cardiac surgery with extracorporeal circulation. Eur J Cardiothorac Surg 1997;11:424-431.[Abstract/Free Full Text]
3. Hammon J.W., Jr, Stump D.A., Kon N.D., et al. Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg 1997;63:1613-1618.[Abstract/Free Full Text]

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