|
_Cardiac Rehabilitation _
By: ateegnos
Despite major advances in cardiopulmonary bypass technology, surgical
techniques, and anesthesia management, central nervous system complications
remain a common problem after cardiopulmonary bypass. There are several
potential causes of brain damage during open-heart surgery, including
prolonged or severe arterial hypotension, as well as emboli emanating from the
cardiopulmonary bypass circuit or the operative field(Benedict RH, 1994,
Newman 1995). In the coronary artery bypass population, advanced age (* or =
75 years) is associated with an 8.9% neurologic deficit rate. Mortality is
increased ninefold in the elderly patient with a neurologic deficit. Cerebral
complications may represent the leading cause of morbidity after cardiac
operations (Mills, 1995, Kuroda Y, 1993). For patients, caregivers and for
funding of health-care systems, cerebral complications and cognitive
dysfunction results in the cardiac patient losing ability to perform daily
activities independently. The National Heart and Lung Institute in London
reports that the incidence of cognitive defects is as high as 60% at 8 days
postoperative with reduction to 25% to 30% incidence at 8 weeks and 12 months
(Mills, 1995). A study in Germany showed that cardiac patients who have
undergone coronary bypass graft (CABG) experienced deficits in orientation,
word fluency, naming, arithmetic, memory, and visuoconstructive tasks.
Cognitive deficits caused by attention and short-tem memory problems impact on
patients achievement in their rehabilitation programs due to the emphasis on
patient education. Many times, learning is significantly impaired and in
result, and affects the patients ability to integrate the information into
their daily activities. As a result, it is believed that simple cognitive
assessment tools may be helpful in identifying with cognitive deficits and may
contribute to improve rehabilitation management aiming at better outcomes and
better living lifestyles for patients.
Word Count: 283
|
