Sudakevych S. Influence of the depth of anesthesia and perfusion modes on the state of cognitive functions of patients with coronary heart disease operated under cardiopulmonary bypass.

The dissertation is devoted to the actual problem of anaesthesiology, perfusiology and intensive care - prevention of cognitive impairments in patients with coronary heart disease. This dissertation aimed at the improvement of efficiency of coronary artery bypass surgical interventions under cardiopulmonary bypass by reducing the percentage of complications related to exposure to the depth of anesthesia and perfusion modes by means of pathogenetically substantiated optimization of anesthesiological management and cardiopulmonary bypass methods. The study included 144 patients with coronary heart disease, who in the period from years 2013 to 2018 were undergoing treatment at the Government Institution "Heart Institute of the Ministry of Health of Ukraine" and who underwent surgical interventions under cardiopulmonary bypass - coronary artery bypass grafting. In the dissertation the condition and changes of cognitive function of patients with coronary heart disease during coronary bypass surgery with artificial blood circulation at the preoperative stage, on the 4th and 7th day, as well as 3 months after the operation, were researched and analyzed. The methodology of research was based on the evaluation of the general medical condition of patients; cardiac output and systemic hemodynamics; determination of the degree of influence of different types of the depth of anesthesia and perfusion modes on biochemical parameters reflecting the tissue perfusion adequacy; evaluation of the oxygen-transporting function of blood and correspondence between delivery of oxygen and its use. Based on the said indicators, the groups and subgroups were comparable. Neurocognitive function was investigated using the following types of tests: stacking sticks into holes according to the shape (Grooved pegboard); reproduction of digits and letters sequence (Trial Making Test Parts A and B); mini-mental state examination (MMSE); tear of memorization of 10 words according to A. R. Luria. It was found in the course of the study that at all stages of the study the number of patients registered with post operative cognitive dysfunctions (POCDs) was higher in the group with an anesthesia depth level maintained at <40.