Delirium in cardiac surgery: epidemiology, pathogenesis and prevention highlights (Review)

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Symptomatic delirium of the early postoperative period is a qualitative disorder (clouding) of consciousness that is deferred, occurs under mainly vascular, inflammatory and metabolic alterations, manifests by variant behavioral disorders. Three clinical studies were conducted to assess the state of the brain after the most frequent elective cardiac surgery — coronary bypass surgery, open-heart valve surgery, open-heart and endovascular aortic valve surgery. 306 patients were included in the listed studies, the controls included the results of the examination of 120 patients who underwent elective eversion carotid endarterectomy and 15 patients who underwent elective abdominal aortic prosthetics. Thus, 441 patients underwent perioperative neurological examination according to a single algorithm. According to the results of the conducted studies, the frequency of symptomatic delirium of the early postoperative period during elective cardiac surgery is 12–14%. Symptomatic delirium of the early postoperative period commonly develops 1–3 days after surgery, the average duration is from 1 to 3 days. Symptomatic delirium of the early postoperative period also increases the likelihood of subsequent development of other clinical types of postoperative cerebral dysfunction – perioperative stroke and deferred cognitive impairment. Most of the symptomatic delirium of the early postoperative period risk factors are preoperative and have vascular origin. Combined use of CAM-ICU and RASS scales is recommended for screening diagnostics of symptomatic delirium of the early postoperative period. The increase of the number of cardiac surgeries demonstrates the necessity of the further improvement of perioperative cerebroprotection, the main directions are promptly diagnosis and correction of risk factors, as well as the use of non-pharmacological and pharmacological methods of brain protection, including the original four-component (inosine, nicotinamide, riboflavin, succinic acid) neuroprotector with cytoprotective and antihypoxic effects, as well as meglumine sodium succinate with antihypoxic and anti-inflammatory effects.

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Nikolay V. Tsygan

Kirov Military Medical Academy; B.P. Konstantinov Petersburg Nuclear Physics Institute of National Research Centre “Kurchatov Institute”

Author for correspondence.
ORCID iD: 0000-0002-5881-2242
SPIN-code: 1006-2845
Scopus Author ID: 37066611200
ResearcherId: H-9132-2016

MD, PhD, Dr. Sci. (Med.), Assistant Professor, Deputy Head of the Department of Nervous Diseases; Leading Research Associate

Russian Federation, Saint Petersburg; Gatchina, Leningrad Region

Aleksandr V. Ryabtsev

Kirov Military Medical Academy

ORCID iD: 0000-0002-3832-2780
SPIN-code: 9915-4960
Scopus Author ID: 57202361039
ResearcherId: AAD-3948-2019


Russian Federation, Saint Petersburg

Olga S. Sandalova

Consultative and Diagnostic Center No. 85

SPIN-code: 4048-7568


Russian Federation, Saint Petersburg

Ruslan V. Andreev

Kirov Military Medical Academy

ORCID iD: 0000-0002-4845-5368
SPIN-code: 8521-5795

MD, PhD, Head of Nervous Diseases Department

Russian Federation, Saint Petersburg

Aleksandr P. Trashkov

B.P. Konstantinov Petersburg Nuclear Physics Institute of National Research Centre “Kurchatov Institute”; National Research Center “Kurchatov Institute”

ORCID iD: 0000-0002-3441-0388
SPIN-code: 4231-1258
ResearcherId: E-9576-2016

MD, PhD, Head of the Department

Russian Federation, Gatchina, Leningrad Region; Moscow

Andrey S. Peleshok

Kirov Military Medical Academy

ORCID iD: 0000-0002-6977-611X
SPIN-code: 4874-4366


Russian Federation, Saint Petersburg

Evgeniy S. Kurasov

Kirov Military Medical Academy

ORCID iD: 0000-0003-3616-6574
SPIN-code: 4961-0342

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Igor V. Litvinenko

Kirov Military Medical Academy

ORCID iD: 0000-0001-8988-3011
SPIN-code: 6112-2792
Scopus Author ID: 35734354000
ResearcherId: F-9120-2013

MD, PhD, Dr. Sci. (Med.), Professor, Head of the Department of Nervous Diseases

Russian Federation, Saint Petersburg


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Supplementary files

Supplementary Files
1. Fig. 1. Pathogenesis of delirium (cited [3])

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2. Fig. 2. Post-surgery cerebral dysfunction and post-surgery cognitive improvement after surgery

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