• Central

• D = Neurological

  • Postoperative NCD = Neurocognitive Disorder
  • Stroke
  • TIA
  • Gas emboli
  • Ischaemic SCI
  • Delirium
  • Risk
    • Patient = elderly, HTN, stroke, DM, carotid stenosis
    • Surgical = duration, microemboli
    • Anaesthetic = low MAP = low CPP

• Peripheral

• D = Neurological

  • Brachial plexus injury = CVC, positioning, sternal retraction
  • Ulnar N injury = positioning
  • Phrenic N injury
  • RLN injury = prolonged intubation, surgical dissection
  • Saphenous N injury
  • Intercostal N injury

# Reducing central neurological complications

• Preop

• Intraop

• Surgical

  • minimally invasive techniques = ⬇stress response
  • avoid disrupting aortic plaques = clamping, cannulating

• Anaesthetic

  • C = HD stability
  • D = avoid excessive depth of anaesthesia, cerebral regional oximetry
  • E = Glucose management, avoid fast rewarming (cerebral oedema)
  • K = monitor acid-base balance
  • H = careful ACT monitoring
  • Positioning

• Postop

• Avoid hypoxia

• Manage CV RF = BGL, BP, cholesterol

• Pre-op
• Intra-op
• Post-op