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Xia T, Yang C, Wang X, Bai L, Ma J, Zhao M, Hua W, Wang H. Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study. Front Aging Neurosci 2022; 14:1034041. [PMID: 36337695 PMCID: PMC9634074 DOI: 10.3389/fnagi.2022.1034041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective Postoperative neurocognitive dysfunction (PND) occurs in up to 54% of older patients, giving rise to the heavy psychological and economic burdens to patients and society. To date, the development of PND biomarkers remains a challenge. Heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNPA2/B1) is an RNA-binding protein whose prion-like structure is prone to mutation and hence leads to neurodegenerative diseases, but its expression changes in PND remains unclear. Here, we detect the preoperative hnRNPA2/B1 level in patients with PND, and to explore its value in the prediction and diagnosis of PND. Methods The study included 161 elderly patients undergoing lumbar decompression and fusion in Nankai University Affinity the Third Central Hospital from September 2021 to July 2022. Neuropsychological and psychometric evaluations were performed before surgery, 1 week and 3 months after surgery to diagnose the occurrence of PND, then the peripheral blood was collected from patients before induction of anesthesia. The concentration in plasma of hnRNPA2/B1 and amyloid-β 42 were determined by enzyme-linked immunosorbent assay. The median fluorescence intensity and mRNA levels of hnRNPA2/B1 in peripheral blood mononuclear cells was detected by indirect intracellular staining flow cytometry and quantitative real-time PCR, respectively. Results The preoperative hnRNPA2/B1 level in patients with PND was higher both in short-time and long-time follow-up. We found significantly higher concentrations of hnRNPA2/B1 in PND at 7 days after surgery (median, 72.26 pg/mL vs. 54.95 pg/mL, p = 0.022) compared with patients without PND, and so as 3 months after surgery (median, 102.93 pg/mL vs. 56.38 pg/mL, p = 0.012). The area under the curve (AUC) was predicted to be 0.686 at 7 days after surgery and 0.735 at 3 months. In addition, when combining several clinical information, the diagnostic efficiency of hnRNPA2/B1 for PND could further increase (AUC, 0.707 at 7 days, 0.808 at 3 months). Conclusion Based on the findings reported here, hnRNPA2/B1 may serve as a new and powerful predictive biomarker to identify elderly patients with PND.
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Affiliation(s)
- Tong Xia
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Chenyi Yang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Xinyi Wang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Lili Bai
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Ji Ma
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Mingshu Zhao
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Wei Hua
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Haiyun Wang
- Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Anesthesiology, Nankai University Affinity the Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
- *Correspondence: Haiyun Wang,
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Electroacupuncture Stimulation Suppresses Postoperative Inflammatory Response and Hippocampal Neuronal Injury. Mediators Inflamm 2022; 2022:3288262. [PMID: 36110099 PMCID: PMC9470349 DOI: 10.1155/2022/3288262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is consequence of anesthesia and surgery that primarily affects older people. The prevention and treatment of POCD has drawn an increasing attention in recent decades. Here, we established the animal model mimicked POCD after femoral fracture surgery, and analyze the effect of acupuncture stimulation on postoperative cognitive function after femoral fracture surgery. Compared with the mock group, the cognitive function performance was significantly decreased both in the anaesthesia group and the surgery group, between which the symptoms were more severe in the surgery group. The peripheral inflammation response and the neuron impairment and inflammation response in the hippocampus were observed in the surgery group, but only peripheral inflammation response was detected in the anaesthesia group. These findings indicated the POCD was the synergistic outcome of anaesthesia and surgical stimulation but with different pathogenic mechanism. The surgery with mental tri-needles (surgery+MTN) group outperformed the surgery group in terms of cognitive function performance. The peripheral inflammation response and the neuron impairment and inflammation response in the hippocampus was significantly reduced by the electroacupuncture stimulation. Our findings indicated the protection of electroacupuncture form POCD after femoral fracture surgery is related to the inhibition of inflammation response and neuron impairment.
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Zhu S, Zheng Z, Lv W, Ouyang P, Han J, Zhang J, Dong H, Lei C. Neuroprotective effect of remote ischemic preconditioning in patients undergoing cardiac surgery: A randomized controlled trial. Front Cardiovasc Med 2022; 9:952033. [PMID: 36148077 PMCID: PMC9485807 DOI: 10.3389/fcvm.2022.952033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background The neuroprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing elective cardiopulmonary bypass (CPB)-assisted coronary artery bypass graft (CABG) or valvular cardiac surgery remains unclear. Methods A randomized, double-blind, placebo-controlled superior clinical trial was conducted in patients undergoing elective on-pump coronary artery bypass surgery or valve surgery. Before anesthesia induction, patients were randomly assigned to RIPC (three 5-min cycles of inflation and deflation of blood pressure cuff on the upper limb) or the control group. The primary endpoint was the changes in S-100 calcium-binding protein β (S100-β) levels at 6 h postoperatively. Secondary endpoints included changes in Neuron-specific enolase (NSE), Mini-mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) levels. Results A total of 120 patients [mean age, 48.7 years; 36 women (34.3%)] were randomized at three cardiac surgery centers in China. One hundred and five patients were included in the modified intent-to-treat analysis (52 in the RIPC group and 53 in the control group). The primary result demonstrated that at 6 h after surgery, S100-β levels were lower in the RIPC group than in the control group (50.75; 95% confidence interval, 67.08 to 64.40 pg/ml vs. 70.48; 95% CI, 56.84 to 84.10 pg/ml, P = 0.036). Compared to the control group, the concentrations of S100-β at 24 h and 72 h and the concentration of NSE at 6 h, 24 h, and 72 h postoperatively were significantly lower in the RIPC group. However, neither the MMSE nor the MoCA revealed significant between-group differences in postoperative cognitive performance at 7 days, 3 months, and 6 months after surgery. Conclusion In patients undergoing CPB-assisted cardiac surgery, RIPC attenuated brain damage as indicated with the decreased release of brain damage biomarker S100-β and NSE. Clinical trial registration [ClinicalTrials.gov], identifier [NCT01231789].
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Affiliation(s)
- Shouqiang Zhu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Ziyu Zheng
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Wenying Lv
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Pengrong Ouyang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Jiange Han
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
- *Correspondence: Hailong Dong,
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
- Chong Lei,
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Devos JVP, Temel Y, Ackermans L, Visser-Vandewalle V, Onur OA, Schruers K, Smit J, Janssen MLF. Methodological Considerations for Setting Up Deep Brain Stimulation Studies for New Indications. J Clin Med 2022; 11:jcm11030696. [PMID: 35160153 PMCID: PMC8836606 DOI: 10.3390/jcm11030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Deep brain stimulation (DBS) is a neurosurgical treatment with a growing range of indications. The number of clinical studies is expanding because of DBS for new indications and efforts to improve DBS for existing indications. To date, various methods have been used to perform DBS studies. Designing a clinical intervention study with active implantable medical devices has specific challenges while expanding patient treatment. This paper provides an overview of the key aspects that are essential for setting up a DBS study.
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Affiliation(s)
- Jana V. P. Devos
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Ear, Nose, Throat, Head and Neck Surgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence: (J.V.P.D.); (Y.T.)
| | - Yasin Temel
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence: (J.V.P.D.); (Y.T.)
| | - Linda Ackermans
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Oezguer A. Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands;
| | - Jasper Smit
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | - Marcus L. F. Janssen
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
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Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study. Perioper Med (Lond) 2021; 10:37. [PMID: 34743734 PMCID: PMC8574052 DOI: 10.1186/s13741-021-00208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homocysteine, folate, and vitamin B12 involved in 1-carbon metabolism are associated with cognitive disorders. We sought to investigate the relationships between these factors and delayed neurocognitive recovery (dNCR) after non-cardiac surgery. METHODS This was a prospective observational study of patients (n = 175) who were ≥ 60 years of age undergoing non-cardiac surgery. Patients were evaluated preoperatively and for 1 week postoperatively by using neuropsychological tests and were divided into dNCR or non-dNCR groups according to a Z-score ≤ - 1.96 on at least two of the tests. The relationship between the occurrence of dNCR and preoperative levels of homocysteine, folate, and vitamin B12 was analyzed. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with dNCR. RESULTS Delayed neurocognitive recovery was observed in 36 of 175 patients (20.6%; 95% confidence interval [CI], 14.5-26.6%) 1 week postoperatively. Patients who developed dNCR had significantly higher median [interquartile range (IQR)] homocysteine concentrations (12.8 [10.9,14.4] μmol/L vs 10.6 [8.6,14.7] μmol/L; P = 0.02) and lower folate concentrations (5.3 [4.2,7.3] ng/mL vs 6.9 [5.3,9.5] ng/mL; P = 0.01) than those without dNCR. Compared to the lowest tertile, the highest homocysteine tertile predicted dNCR onset (odds ratio [OR], 3.9; 95% CI, 1. 3 to 11.6; P = 0.02), even after adjusting for age, sex, education, and baseline Mini Mental State Examination. CONCLUSIONS Elderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures. TRIAL REGISTRATION NCT03084393 ( https://www.clinicaltrials.gov ).
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Chawdhary AA, Kulkarni A, Nozari A. Substitution of propofol for dexmedetomidine in the anaesthetic regimen does not ameliorate the post-operative cognitive decline in elderly patients. Indian J Anaesth 2020; 64:880-886. [PMID: 33437077 PMCID: PMC7791422 DOI: 10.4103/ija.ija_365_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/18/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Post-operative cognitive dysfunction (POCD) is a poorly understood complication particularly observed in elderly patients, with long-term poor outcome. The randomised study was to compare the incidence of POCD in elderly with bispectral index (BIS)-guided intra-operative use of either dexmedetomidine or propofol with sevoflurane. Methods: Eighty-seven patients, planned for non-cardiac surgery under general anaesthesia, were included between June 2017 and March 2018. After exclusion of 7 patients, remaining 80 patients were randomised into dexmedetomidine group and propofol group with 40 patients each. In both the groups, BIS-guided anaesthesia was provided. Cognitive function was assessed by an anaesthesiologist using a battery of neuropsychological tests at baseline pre-operatively, third and seventh day after surgery. The data were entered into a Microsoft Excel spreadsheet and analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Results: Propofol group had a non-significant lower incidence of POCD on third day and dexmedetomidine group showed decreased incidence of POCD on seventh day, accompanied by lower anaesthetic requirement (inhalational as well as intravenous) concomitant with delayed emergence with an acceptable BIS value. Conclusion: Dexmedetomidine appeared to be anaesthetic sparing as compared to propofol. BIS monitoring for titrating depth of anaesthesia and hence the anaesthetic exposure is an invaluable tool as compared to routine care anaesthesia for reducing POCD. The patients in both groups did not develop significant POCD until the seventh post-operative day.
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Affiliation(s)
- Abrar A Chawdhary
- Department of Anaesthesiology and Critical Care, Dr. Baba Saheb Ambedkar Hospital and Medical College, Rohini, Delhi, India
| | - Anita Kulkarni
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Ala Nozari
- Department of Anaesthesiology, Boston University School of Medicine, Boston, MA, United States
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Tsapakis EM, Tsiridis E, Hunter A, Gamie Z, Georgakarakos N, Thomas P, Schizas C, West RM. Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: A prospective population-based cohort study. Eur Psychiatry 2020; 24:112-8. [DOI: 10.1016/j.eurpsy.2008.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 09/02/2008] [Accepted: 09/07/2008] [Indexed: 11/17/2022] Open
Abstract
AbstractObjectiveThe effect of minor orthopaedic day surgery (MiODS) on patient’s mood.MethodsA prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of general anaesthesia (GA) were included. The Medical Outcomes Study – Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and post-operatively.ResultsThe mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n= 148,p= 0.51, 95% CI = (−1.03 to 1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient,r= 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well withχ2(df = 1) = 0.86 for whichp= 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.ConclusionsMiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.
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Abstract
Postoperative cognitive dysfunction (POCD) is a major complication affecting patients of any age undergoing surgery. This syndrome impacts everyday life up to months after hospital discharge, and its pathophysiology still remains unclear. Translational research focusing on POCD is based on a wide variety of rodent models, such as the murine tibial fracture, whose severity can limit mouse locomotion and proper behavioral assessment. Besides, influence of skeletal muscle injury, a lesion encountered in a wide range of surgeries, has not been explored in POCD occurrence. We propose a physical model of muscle injury in CX3CR1GFP/+ mice (displaying green fluorescent microglial cells) to study POCD, with morphological, behavioral and molecular approaches. We highlighted: alteration of short- and long-term memory after muscle regeneration, wide microglial reactivity in the brain, including hippocampus area, 24 hours after muscle injury, and an alteration of central brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) balance, 28 days after muscle injury. Our results suggest for the first time that muscle injury can have early as well as late impacts on the brain. Our CX3CR1GFP/+ model can also facilitate microglial investigation, more specifically their pivotal role in neuroinflammation and synaptic plasticity, in the pathophysiology of POCD.
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Mohamed S, Shaaban AR. The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sahar Mohamed
- Faculty of Medicine, Ain Shams University , Cairo, Egypt
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Nassif EF, Arsène-Henry A, Kirova YM. Brain metastases and treatment: multiplying cognitive toxicities. Expert Rev Anticancer Ther 2019; 19:327-341. [PMID: 30755047 DOI: 10.1080/14737140.2019.1582336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Thirty per cent of cancer patients develop brain metastases, with multiple combination or sequential treatment modalities available, to treat systemic or central nervous system (CNS) disease. Most patients experience toxicities as a result of these treatments, of which cognitive impairment is one of the adverse events most commonly reported, causing major impairment of the patient's quality of life. Areas covered: This article reviews the role of cancer treatments in cognitive decline of patients with brain metastases: surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapies and hormone therapy. Pathological and molecular mechanisms, as well as future directions for limiting cognitive toxicities are also presented. Other causes of cognitive impairment in this population are discussed in order to refine the benefit-risk balance of each treatment modality. Expert opinion: Cumulative cognitive toxicity should be taken into account, and tailored to the patient's cognitive risk in the light of the expected survival benefit. Standardization of cognitive assessment in this context is needed in order to better appreciate each treatment's responsibility in cognitive impairment, keeping in mind disease itself impacts cognition in this context.
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Affiliation(s)
- Elise F Nassif
- a Department of Radiotherapy , Institut Curie , Paris , France
| | | | - Youlia M Kirova
- a Department of Radiotherapy , Institut Curie , Paris , France
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Ferreira DH, Boland JW, Phillips JL, Lam L, Currow DC. The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review. Palliat Med 2018; 32:786-803. [PMID: 29299954 DOI: 10.1177/0269216317746583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety. AIM To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness. DESIGN Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909. DATA SOURCES Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools. RESULTS From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance. CONCLUSION This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
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Affiliation(s)
- Diana H Ferreira
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Jason W Boland
- 2 Hull York Medical School, University of Hull, Hull, UK
| | - Jane L Phillips
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Lawrence Lam
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.,2 Hull York Medical School, University of Hull, Hull, UK.,3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,4 Wolfson Centre for Palliative Care Research, Hull York Medical School, University of Hull, Hull, UK
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Kotekar N, Shenkar A, Hegde AA. Anesthesia Issues in Geriatrics. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Paredes S, Cortínez L, Contreras V, Silbert B. Post-operative cognitive dysfunction at 3 months in adults after non-cardiac surgery: a qualitative systematic review. Acta Anaesthesiol Scand 2016; 60:1043-58. [PMID: 27027720 DOI: 10.1111/aas.12724] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults. METHODS A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute. RESULTS We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies). CONCLUSIONS Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.
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Affiliation(s)
- S. Paredes
- Anesthesiology Division; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - L. Cortínez
- Anesthesiology Division; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - V. Contreras
- Anesthesiology Division; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - B. Silbert
- Centre for Anaesthesia and Cognitive Function; Department of Anaesthesia; St Vincent's Hospital; Melbourne Fitzroy Vic. Australia
- Anaesthesia; Perioperative and Pain Medicine Unit; Melbourne Medical School; University of Melbourne; Melbourne Vic. Australia
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Schoenenberger AW, Burkhard FC, Thalmann GN, Wuethrich PY. Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study. Urology 2016; 92:63-9. [DOI: 10.1016/j.urology.2016.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/11/2016] [Accepted: 02/20/2016] [Indexed: 11/30/2022]
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Hovens IB, van Leeuwen BL, Mariani MA, Kraneveld AD, Schoemaker RG. Postoperative cognitive dysfunction and neuroinflammation; Cardiac surgery and abdominal surgery are not the same. Brain Behav Immun 2016; 54:178-193. [PMID: 26867718 DOI: 10.1016/j.bbi.2016.02.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/25/2016] [Accepted: 02/07/2016] [Indexed: 12/21/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. To gain insight in the mechanisms underlying the higher incidence of POCD after cardiac versus non-cardiac surgery, systemic and central inflammatory changes, alterations in intraneuronal pathways, and cognitive performance were studied after cardiac and abdominal surgery in rats. Male Wistar rats were subjected to ischemia reperfusion of the upper mesenteric artery (abdominal surgery) or the left coronary artery (cardiac surgery). Control rats remained naïve, received anesthesia only, or received thoracic sham surgery. Rats were subjected to affective and cognitive behavioral tests in postoperative week 2. Plasma concentrations of inflammatory factors, and markers for neuroinflammation (NGAL and microglial activity) and the BDNF pathway (BDNF, p38MAPK and DCX) were determined. Spatial memory was impaired after both abdominal and cardiac surgery, but only cardiac surgery impaired spatial learning and object recognition. While all surgical procedures elicited a pronounced acute systemic inflammatory response, NGAL and TNFα levels were particularly increased after abdominal surgery. Conversely, NGAL in plasma and the paraventricular nucleus of the hypothalamus and microglial activity in hippocampus and prefrontal cortex on postoperative day 14 were increased after cardiac, but not abdominal surgery. Both surgery types induced hippocampal alterations in BDNF signaling. These results suggest that POCD after cardiac surgery, compared to non-cardiac surgery, affects different cognitive domains and hence may be more extended rather than more severe. Moreover, while abdominal surgery effects seem limited to hippocampal brain regions, cardiac surgery seems associated with more wide spread alterations in the brain.
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Affiliation(s)
- Iris B Hovens
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands; Department of Surgery and Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Barbara L van Leeuwen
- Department of Surgery and Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Regien G Schoemaker
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands; Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Oeffinger KC, Fontham ETH, Etzioni R, Herzig A, Michaelson JS, Shih YCT, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AMD, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA 2015; 314:1599-614. [PMID: 26501536 PMCID: PMC4831582 DOI: 10.1001/jama.2015.12783] [Citation(s) in RCA: 1040] [Impact Index Per Article: 115.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. OBJECTIVE To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. PROCESS The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. EVIDENCE SYNTHESIS Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk. RECOMMENDATIONS The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation). CONCLUSIONS AND RELEVANCE These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.
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Affiliation(s)
| | | | - Ruth Etzioni
- University of Washington and the Fred Hutchinson Cancer Research Center, Seattle
| | | | | | | | - Louise C Walter
- University of California, San Francisco, and San Francisco VA Medical Center
| | - Timothy R Church
- Masonic Cancer Center and the University of Minnesota, Minneapolis
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Liu LL, Bao N, Lu HW. Effects of CO 2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy. Gynecol Obstet Invest 2015; 81:90-5. [DOI: 10.1159/000376576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
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Xu X, Wang Y, Zhang J, Du Y, Li Y, Xing N, Wei X, Li Z, Wang Z, Xue J, Yan J, Zhang W. The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery. Transfus Apher Sci 2015; 53:48-51. [PMID: 25907924 DOI: 10.1016/j.transci.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/14/2015] [Accepted: 03/06/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Intraoperation autologous blood transfusion is an effective method that is used in surgeries with an important blood loss. Several studies suggest that massive blood transfusion is one of the independent risks for postoperative cognitive dysfunction (POCD). Whether the autologous blood is one of the risk factor for POCD or not, we retrospectively examined the incidence of POCD and the probable risk factors in patients undergoing lumbar surgery in our hospital, with the same aged non-POCD patients as controls. METHODS Eighty-one patients who underwent lumbar surgery were included. Perioperative data were examined for association with POCD on the 7 postoperative days by a Mini-Mental State Test. Multivariable logistic regression analysis was conducted to determine the probable risks associated with POCD. RESULTS POCD was found in 21 patients. Participants who developed POCD were more likely to had a lower eduction level, more likely to had more blood loss, higher incidence of preoperative anemia, and perioperative allogeneic blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively (P < 0.05). Otherwise, there is no significant difference of the patients received autologous blood or not (P > 0.05). CONCLUSION Autologous blood transfusion is not a risk factor for POCD in aged patients following lumbar surgery. Autologous blood is likely to be a better method of intraoperative blood transfusion during lumbar spine surgery.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Ying Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jie Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yingying Du
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yanna Li
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Na Xing
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Xin Wei
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhisong Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhongyu Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jinhu Xue
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jie Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China.
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Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Pagel PS. Remote Ischemic Preconditioning Prevents Deterioration of Short-Term Postoperative Cognitive Function After Cardiac Surgery Using Cardiopulmonary Bypass: Results of a Pilot Investigation. J Cardiothorac Vasc Anesth 2015; 29:382-8. [DOI: 10.1053/j.jvca.2014.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 11/11/2022]
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Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X, Guo X, Shen R, Xia X, Liu Y, Wang F. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Med Sci Monit 2014; 20:1908-12. [PMID: 25306127 PMCID: PMC4206478 DOI: 10.12659/msm.892485] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a subtle disorder of thought processes, which may influence isolated domains of cognition and has a significant impact on patient health. The reported incidence of POCD varies enormously due to lack of formal criteria for the assessment and diagnosis of POCD. The significant risk factors of developing POCD mainly include larger and more invasive operations, duration of anesthesia, advanced age, history of alcohol abuse, use of anticholinergic medications, and other factors. The release of cytokines due to the systemic stress response caused by anesthesia and surgical procedures might induce the changes of brain function and be involved in the development of postoperative cognitive dysfunction. The strategies for management of POCD should be a multimodal approach involving close cooperation between the anesthesiologist, surgeon, geriatricians, and family members to promote early rehabilitation and avoid loss of independence in these patients.
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yan Wang
- Department of Anesthesiology, Affiliated Chaohu Hospital, Anhui Medical University, Chaohu, Anhui, China (mainland)
| | - Haibo Wu
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Liming Lei
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Shiqin Xu
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xiaofeng Shen
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xirong Guo
- Pediatric Institute, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Rong Shen
- Pediatric Institute, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xiaoqiong Xia
- Department of Anesthesiology, Affiliated Chaohu Hospital, Anhui Medical University, Chaohu, Anhui, China (mainland)
| | - Yusheng Liu
- Department of Anesthesiology, Nanjing Medical University, Nanjing, China (mainland)
| | - Fuzhou Wang
- Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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21
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The temporal relationship between early postoperative delirium and postoperative cognitive dysfunction in older patients: a prospective cohort study. Can J Anaesth 2014; 61:1084-92. [PMID: 25287962 DOI: 10.1007/s12630-014-0242-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Postoperative delirium and cognitive dysfunction are frequent phenomena in older patients; however, few studies have examined the temporal relationship between these two conditions in the early postoperative period. Therefore, this study aimed to determine if postoperative delirium and postoperative cognitive dysfunction (POCD) coexist after major noncardiac surgery. METHODS This was a prospective cohort study of patients who were ≥ 65 yr of age undergoing noncardiac surgery. Patients were evaluated preoperatively and for two days postoperatively for delirium and POCD. Delirium was determined using the Confusion Assessment Method, and POCD was measured by three cognitive tests addressing changes in executive function, memory, attention, and concentration. For each postoperative day, patients' neurologic status was categorized into three mutually exclusive categories: delirium, POCD, or neither condition. RESULTS Four hundred sixty-one patients aged ≥ 65 yr of age were studied, and 421 patients with complete postoperative cognitive testing were reported. Eighty percent of patients experienced either delirium or POCD on the first day after surgery. Seventy percent of patients who had delirium on the first postoperative day also had delirium on the second postoperative day. Sixty-three percent of patients who had POCD on postoperative day one continued to have POCD on the next day. Sixteen percent of patients with delirium on day one were non-delirious on day two but met criteria for POCD on day two. Conversely, 15% of patients with POCD on day one became delirious on day two. Only 13% of patients did not experience delirium or POCD on either day after surgery. CONCLUSIONS Eighty percent of surgical patients experienced some form of cognitive dysfunction the day after surgery, and few recovered by the second day after surgery.
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22
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Pomykala KL, de Ruiter MB, Deprez S, McDonald BC, Silverman DHS. Integrating imaging findings in evaluating the post-chemotherapy brain. Brain Imaging Behav 2014; 7:436-52. [PMID: 23828813 DOI: 10.1007/s11682-013-9239-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive complaints following cancer and cancer therapy are common. Many studies have investigated the effects of chemotherapy on the brain. However, the mechanisms for the associated cognitive impairment are not well understood. Some studies have also included brain imaging to investigate potential neurological substrates of cognitive changes. This review examines recent neuroimaging studies on cancer- and chemotherapy-related cognitive dysfunction in non-central nervous system cancers and compares findings across imaging modalities. Grey matter volume reductions and decreases in white matter integrity are seen after exposure to adjuvant chemotherapy for breast cancer, and functional studies have illuminated both hypo- and hyperactivations in many of the same regions months to years following therapy. These comparisons can assist in further characterizing the dysfunction reported by patients and contribute to a better understanding of the mechanisms involved.
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Affiliation(s)
- K L Pomykala
- Ahmanson Translational Imaging Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Salazar F, Doñate M, Boget T, Bogdanovich A, Basora M, Torres F, Gracia I, Fàbregas N. Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis. BMC Anesthesiol 2014; 14:58. [PMID: 25061427 PMCID: PMC4109378 DOI: 10.1186/1471-2253-14-58] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function. Methods Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms. Results We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034). Conclusions Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.
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Affiliation(s)
- Fátima Salazar
- Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Marta Doñate
- Department of Neuropsychology, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Teresa Boget
- Department of Neuropsychology, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Ana Bogdanovich
- Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Misericordia Basora
- Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Ferran Torres
- Statistics & Methodology Support Unit (USEM), IDIBAPS, (Hospital Clinic de Barcelona), Laboratory of Biostatistics & Epidemiology (Universitat Autonoma de Barcelona), Barcelona, Spain
| | - Isabel Gracia
- Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
| | - Neus Fàbregas
- Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain
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Kotekar N, Kuruvilla CS, Murthy V. Post-operative cognitive dysfunction in the elderly: A prospective clinical study. Indian J Anaesth 2014; 58:263-8. [PMID: 25024467 PMCID: PMC4090990 DOI: 10.4103/0019-5049.135034] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: Aging population is a major demographic trend worldwide. Globally, 50% of all the elderly individuals are estimated to undergo atleast one surgical procedure and post-operative cognitive dysfunction (POCD) is one of the most common and often poorly understood post-operative complications in this section of the population. This randomised prospective study was conducted to assess the post-operative cognitive status in the elderly undergoing non-cardiac surgery, evaluate the cognitive parameters affected, evaluate the potential risk factors and thereby analyse the potential for implementation of preventive strategies. Methods: This study was conducted on 200 patients aged 60 years or older scheduled for elective non-cardiac surgeries. The baseline cognitive status of the patients was assessed 2 days prior to the date of the surgery. The post-operative cognitive status was assessed on the 3rd day, 7th day and after 1 month. Statistical analysis was performed using SAS and SPSS. Results: The incidence of POCD showed a gradual decline from postoperative day 3 to 30. Females were found to be at significant risk in developing POCD. Advancing age and level of education emerged as dominant factors, while type of anaesthesia, duration of surgery, and presence of coexisting comorbidities had no influence on the incidence of cognitive dysfunction. Conclusion: POCD is a definite complication after surgery and anaesthesia in the elderly population. Gender emerged as a significant risk factor with increasing age as a dominating factor contributing to POCD.
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Affiliation(s)
- Nalini Kotekar
- Department of Anaesthesiology, JSS Medical College, Mysore, Karnataka, India
| | | | - Vishakantha Murthy
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
IMPORTANCE Guidelines recommend individualizing screening mammography decisions for women aged 75 years and older. However, little pragmatic guidance is available to help counsel patients. OBJECTIVE To provide an evidence-based approach for individualizing decision-making about screening mammography in older women. EVIDENCE ACQUISITION We searched PubMed for English-language studies in peer-reviewed journals published from January 1, 1990, to February 1, 2014, to identify risk factors for late-life breast cancer in women aged 65 years and older and to quantify the benefits and harms of screening mammography for women aged 75 years and older. FINDINGS Age is the major risk factor for developing and dying from breast cancer. Breast cancer risk factors that reflect hormonal exposures in the distant past, such as age at first birth or age at menarche, are less predictive of late-life breast cancer than factors indicating recent hormonal exposures such as high bone mass or obesity. Randomized trials of the benefits of screening mammography did not include women older than 74 years. Thus it is not known if screening mammography benefits older women. Observational studies favor extending screening mammography to older women who have a life expectancy of more than 10 years. Modeling studies estimate 2 fewer breast cancer deaths/1000 women who in their 70s continue biennial screening for 10 years instead of stopping screening at age 69. Potential harms of continued screening over 10 years include false-positive mammograms in approximately 200/1000 women screened and overdiagnosis (ie, finding breast cancer that would not have clinically surfaced otherwise) in approximately 13/1000 women screened. Providing information about life expectancy along with potential benefits and harms of screening may help older women's decision-making about screening mammography. CONCLUSIONS AND RELEVANCE For women with less than a 10-year life expectancy, recommendations to stop screening mammography should emphasize increased potential harms from screening and highlight health promotion measures likely to be beneficial over the short term. For women with a life expectancy of more than 10 years, deciding whether potential benefits of screening outweigh harms becomes a value judgment for patients, requiring a realistic understanding of screening outcomes.
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Affiliation(s)
- Louise C. Walter
- University of California, San Francisco and the San Francisco VA Medical Center, Boston, MA
| | - Mara A. Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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Early life exposure to sevoflurane impairs adulthood spatial memory in the rat. Neurotoxicology 2013; 39:45-56. [PMID: 23994303 DOI: 10.1016/j.neuro.2013.08.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 12/25/2022]
Abstract
Sevoflurane is a general anesthetic commonly used in the pediatric setting because it is sweet-smelling, nonflammable, fast acting and has a very short recovery time. Although recent clinical data suggest that early anesthesia exposure is associated with subsequent learning and memory problems, it is difficult to determine the exact scope of developmental neurotoxicity associated with exposure to specific anesthetics such as sevoflurane. This is largely due to inconsistencies in the literature. Thus, in the present studies we evaluated the effect of early life exposure to sevoflurane (1%, 2%, 3% or 4%) on adulthood memory impairment in Sprague-Dawley rats. Animals were exposed to different regimens of sevoflurane anesthesia on postnatal days (PNDs) 3, 7, or 14 or at 7 weeks (P7W) of age and spatial memory performance was assessed in adulthood using the Morris Water Maze (MWM). Rats exposed to sevoflurane exhibited significant memory impairment which was concentration and exposure duration dependent. Disruption of MWM performance was more severe in animals exposed on both PNDs 3 and 7 than in animals exposed on both PNDs 3 and 14. The younger the animal's age at the time of exposure, the more significant the effect on later MWM performance. Compared to the neonates, animals exposed at P7W were relatively insensitive to sevoflurane: memory was impaired in this group only after repeated exposures to low doses or single exposures to high doses. Early life exposure to sevoflurane can result in spatial memory impairments in adulthood and the shorter the interval between exposures, the greater the deficit.
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Li M, Yong-Zhe L, Ya-Qun M, Sheng-Suo Z, Li-Tao Z, Ning-Ling P. Ulinastatin alleviates neuroinflammation but fails to improve cognitive function in aged rats following partial hepatectomy. Neurochem Res 2013; 38:1070-7. [PMID: 23508312 DOI: 10.1007/s11064-013-1018-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/17/2013] [Accepted: 03/12/2013] [Indexed: 11/29/2022]
Abstract
Postoperative cognitive dysfunction (POCD) is very common complication of surgery in aged individuals. Accumulated evidence suggests that neuroinflammation may be the underlying cause of POCD. The aim of the present study was to investigate the effects of ulinastatin (UTI) on neuroinflammation and on learning and memory of aged rats after anesthesia and surgery. Our results showed that anesthetic isoflurane increased the hippocampal mRNA level of IL-1β, while surgery of partial hepatectomy increased the hippocampal mRNA levels of IL-1β, TNF-α, and IL-6 as well as impaired rats' spatial memory at day 7 post-surgery. UTI (10,000 U/kg, i.v.) decreased the anesthesia- and surgery-induced increases in mRNA levels of all three cytokines, but did not improve the rats' impaired working memory. In conclusion, moderate and temporary suppression of UTI-induced inflammatory cytokines in hippocampus is not sufficient to alleviate the impairment of working memory.
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Affiliation(s)
- Ma Li
- Department of Anesthesiology, Beijing Military General Hospital of the Chinese People's Liberation Army, Beijing 100700, China.
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Krenk L, Rasmussen LS, Kehlet H. Delirium in the fast-track surgery setting. Best Pract Res Clin Anaesthesiol 2013; 26:345-53. [PMID: 23040285 DOI: 10.1016/j.bpa.2012.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/25/2012] [Indexed: 12/12/2022]
Abstract
Postoperative delirium (PD) and postoperative cognitive dysfunction (POCD) are two separate syndromes of cognitive decline after major surgery, especially in the elderly. Pathogenesis is multifactorial with some common risk factors, and to reduce the risk, a multimodal approach is necessary. The fast-track methodology is becoming a well-established perioperative care regime with possible preventive effects for postoperative cognitive decline, including reduced pain and use of opioids, and early mobilisation with early discharge (≤3 days) to preoperative environment after total hip/knee arthroplasty (THA/TKA). The fast-track set-up seems to be associated with a lower frequency of PD and early POCD after THA/TKA. Thus, in a series of 225 patients ≥60 years, no cases of PD were seen and the incidence of POCD was reduced by more than 50% at 1 week postoperatively compared to previous studies. In conclusion, the fast-track methodology may reduce the incidence of postoperative cognitive decline after surgery.
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Affiliation(s)
- Lene Krenk
- Rigshospitalet, Section of Surgical Pathophysiology, The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen O, Denmark.
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Abstract
BACKGROUND Aseptic surgical trauma provokes a homeostatic neuroinflammatory response to promote healing and protect the organism from further injury. When this response is dysregulated, harmful consequences can follow, including postoperative cognitive decline. SOURCES OF DATA We performed a comprehensive search on PubMed related to postoperative cognitive dysfunction (POCD). AREAS OF AGREEMENT Although the precise pathogenic mechanisms for POCD remain unclear, certain risk factors are known. AREAS OF CONTROVERSY The mechanisms that lead to exaggerated and persistent neuroinflammation and the best way to counteract it are still unknown. AREAS FOR DEVELOPING RESEARCH: It is imperative that we identify the underlying processes that increase the risk of cognitive decline in elderly surgical patients. In this review we explore non-resolution of inflammation as an underlying cause of developing exaggerated and persistent POCD. If interventions can be developed to promote resolution of neuroinflammation, the patient's postoperative recovery will be enhanced and long-term consequences can be prevented.
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Affiliation(s)
- Susana Vacas
- University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143-0648, USA
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Clinical, methodological and theoretical issues in the assessment of cognition after anaesthesia and surgery: a review. Eur J Anaesthesiol 2012; 29:409-22. [PMID: 22828386 DOI: 10.1097/eja.0b013e328356bd6e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As people live longer, the burden of cognitive impairment to elderly patients, their families and society becomes increasingly common and important. The loss of independence, a reduction in the quality of life and increased mortality are possible correlates to the mental disintegration. Cognitive dysfunction following major surgery on the elderly is a significant problem which adds to other cognitive impairments caused by neurodegeneration, cerebrovascular impairments and other causes. There are challenges in reviewing the literature because of many methodological concerns. There is no standard definition; the diagnosis is made only by the results of neuropsychological tests which are not standardised for this purpose; test results are analysed by different statistical methods (some of them inappropriate); controls are often absent or poorly matched; and pre-existing mild cognitive impairment, which affects 10 to 20% of people older than 65 years and is similar to the subtle cognitive impairment following surgery, is not sought for and recognised. Reviews of the subject have varied from descriptions such as 'a well recognised and significant problem' to 'a hypothetical phenomenon for which there is no International Statistical Classification of Disease (ICD-9) code, and no Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) code'. This article examines both sides of the spectrum in a detailed review which explains the necessary psychological 'jargon', discusses the methods used and points to areas of future research.
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Pomykala KL, Silverman DHS. Alterations in brain structure and function after chemotherapy for cancer. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The majority of cancer patients treated with chemotherapy complain of fatigue and/or cognitive dysfunction. Although many patients experience improvement shortly after completion of treatment, a substantial number of patients may continue to be symptomatic for years or even decades after their last dose of chemotherapy. This review focuses on the scope of postchemotherapy cognitive dysfunction, spotlights recent studies that investigate this problem in the short- and long-term, examines neuroimaging studies that document regional cerebral alterations observed after chemotherapy, discusses candidate mechanisms and treatments and finally comments on challenges in the field.
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Affiliation(s)
- Kelsey L Pomykala
- Ahmanson Translational Imaging Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, 200 Medical Plaza, Suite B114, Mail Code: 737024, Los Angeles, CA 90095-7370, USA
| | - Daniel HS Silverman
- Ahmanson Translational Imaging Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, 200 Medical Plaza, Suite B114, Mail Code: 737024, Los Angeles, CA 90095-7370, USA
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Krenk L, Rasmussen LS, Siersma VD, Kehlet H. Short-term practice effects and variability in cognitive testing in a healthy elderly population. Exp Gerontol 2012; 47:432-6. [DOI: 10.1016/j.exger.2012.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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Scherling C, Collins B, MacKenzie J, Bielajew C, Smith A. Prechemotherapy differences in response inhibition in breast cancer patients compared to controls: A functional magnetic resonance imaging study. J Clin Exp Neuropsychol 2012; 34:543-60. [DOI: 10.1080/13803395.2012.666227] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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LI YC, XI CH, AN YF, DONG WH, ZHOU M. Perioperative inflammatory response and protein S-100β concentrations - relationship with post-operative cognitive dysfunction in elderly patients. Acta Anaesthesiol Scand 2012; 56:595-600. [PMID: 22224444 DOI: 10.1111/j.1399-6576.2011.02616.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND One major concern in about one third of elder patients after total hip-replacement surgery is post-operative cognitive dysfunction (POCD). Previous studies have suggested that cognitive impairment is accompanied with changes in serum S-100β protein (S-100β) and inflammatory markers. Thus, the aim of the current study was to investigate the value of serum S-100β and interleukin(IL)-1β, IL-6, tumour necrosis factor-α (TNF-α), and C-reactive protein (CRP) in reflecting POCD after total hip-replacement surgery. METHODS Forty-two elderly patients were enrolled, and 37 patients completed the follow-up. Serum S-100β protein and IL-1β, IL-6, TNF-α, and CRP were determined pre-operatively, as well as 1 h and 6 h post-operatively. Neuropsychological tests were performed pre-operatively, as well as on day 1, 3, and 7 post-operatively. RESULTS Seventeen (45.9%, 17/37) patients developed POCD 1 day after surgery, and three (8.1%, 3/37) developed POCD 7 days after surgery. [Correction added after publication 7 February 2012: in the preceding sentence (54.1%, 17/37) was corrected to (45.9%, 17/37)]. Patients with POCD 1 day after surgery had significantly higher serum levels of IL-6 at 6 h (135 ± 32 pg/ml vs. 91 ± 29 pg/ml, P < 0.05) and S-100β at 1 h (1872 ± 385 pg/ml vs. 1289 ± 143 pg/ml, P < 0.05. No significant post-operative change was detected in levels of TNF-α, IL-1, or CRP. CONCLUSION The serum levels of pro-inflammatory marker IL-6 and S-100β protein increased after total hip-replacement in elderly patients, and such increase may serve as predicting parameters for the occurrence of POCD.
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Affiliation(s)
- Y-C. LI
- Department of Anesthesiology; the Sixth People's Hospital Affiliated to Shanghai Jiaotong University; Shanghai; China
| | - C-H. XI
- Department of Anesthesiology; the Sixth People's Hospital Affiliated to Shanghai Jiaotong University; Shanghai; China
| | - Y-F. AN
- Department of Anesthesiology; the Sixth People's Hospital Affiliated to Shanghai Jiaotong University; Shanghai; China
| | - W-H. DONG
- Department of Anesthesiology; the Sixth People's Hospital Affiliated to Shanghai Jiaotong University; Shanghai; China
| | - M. ZHOU
- Department of Anesthesiology; the Sixth People's Hospital Affiliated to Shanghai Jiaotong University; Shanghai; China
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Scherling C, Collins B, MacKenzie J, Bielajew C, Smith A. Pre-chemotherapy differences in visuospatial working memory in breast cancer patients compared to controls: an FMRI study. Front Hum Neurosci 2011; 5:122. [PMID: 22053153 PMCID: PMC3205481 DOI: 10.3389/fnhum.2011.00122] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 10/10/2011] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cognitive deficits are a side-effect of chemotherapy, however pre-treatment research is limited. This study examines neurofunctional differences during working memory between breast cancer (BC) patients and controls, prior to chemotherapy. METHODS Early stage BC females (23), scanned after surgery but before chemotherapy, were individually matched to non-cancer controls. Participants underwent functional magnetic resonance imaging (fMRI) while performing a Visuospatial N-back task and data was analyzed by multiple group comparisons. fMRI task performance, neuropsychological tests, hospital records, and salivary biomarkers were also collected. RESULTS There were no significant group differences on neuropsychological tests, estrogen, or cortisol. Patients made significantly fewer commission errors but had less overall correct responses and were slower than controls during the task. Significant group differences were observed for the fMRI data, yet results depended on the type of analysis. BC patients presented with increased activations during working memory compared to controls in areas such as the inferior frontal gyrus, insula, thalamus, and midbrain. Individual group regressions revealed a reverse relationship between brain activity and commission errors. CONCLUSION This is the first fMRI investigation to reveal neurophysiological differences during visuospatial working memory between BC patients pre-chemotherapy and controls. These results also increase the knowledge about the effects of BC and related factors on the working memory network. SIGNIFICANCE This highlights the need to better understand the pre-chemotherapy BC patient and the effects of associated confounding variables.
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Affiliation(s)
| | - Barbara Collins
- School of Psychology, University of OttawaOttawa, ON, Canada
- Ottawa HospitalOttawa, ON, Canada
| | | | | | - Andra Smith
- School of Psychology, University of OttawaOttawa, ON, Canada
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Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Pagel PS. Postoperative Delirium and Short-term Cognitive Dysfunction Occur More Frequently in Patients Undergoing Valve Surgery With or Without Coronary Artery Bypass Graft Surgery Compared With Coronary Artery Bypass Graft Surgery Alone: Results of a Pilot Study. J Cardiothorac Vasc Anesth 2011; 25:811-6. [DOI: 10.1053/j.jvca.2010.05.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Indexed: 12/13/2022]
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[Postoperative cognitive dysfunction (POCD): strategy of prevention, assessment and management]. ACTA ACUST UNITED AC 2011; 30:e49-53. [PMID: 21945705 DOI: 10.1016/j.annfar.2011.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The femoral neck fracture is a major cause of morbidity and mortality in the elderly. The etiology of cognitive impairment observed in this population of aged patient seems to be multifactorial. In the strategy of prevention, elderly patient must have the clearer information dealing with the postoperative cognitive dysfunction. This would reduce the incidence of POCD and some cognitive complaints, which often reflect the anxiety of the elderly patient facing the possibility of cognitive impairment. During the anaesthesia consultation, it seems important to assess the cognitive function of this elderly patient (like using neuropsycholgical scale as the MMSE) and to identify associated risk factors of cognitive dysfunction. The management of cognitive disorders should be multidisciplinary, the anesthesiologist being the main referent, in collaboration with the geriatrician and the surgeon. In the clinical setting of femoral neck fracture in the elderly, this multimodal management (pain, nutrition, functional rehabilitation to make these patients autonomous as quickly as possible), seems to improve the functional prognosis and to have the observed POCD decreased.
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Lee JH, Min KT, Chun YM, Kim EJ, Choi SH. Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery. Arthroscopy 2011; 27:889-94. [PMID: 21620637 DOI: 10.1016/j.arthro.2011.02.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 01/17/2011] [Accepted: 02/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE We investigated the effects of the beach-chair position and induced hypotension on regional cerebral oxygen saturation (rSO(2)) in patients undergoing arthroscopic shoulder surgery by using near-infrared spectroscopy. METHODS Twenty-eight patients scheduled for arthroscopic shoulder surgery were enrolled prospectively. After induction of anesthesia, mechanical ventilation was controlled to maintain Paco(2) at 35 to 40 mm Hg. Anesthesia was maintained with sevoflurane and remifentanil. After radial artery cannulation, mean arterial pressure (MAP) was measured at the external auditory meatus level and maintained between 60 and 65 mm Hg. The rSO(2) was measured by use of near-infrared spectroscopy. MAP and rSO(2) were recorded at the following times: before induction (T(0)), immediately after induction (T(1) [baseline]), after beach-chair position (T(2)), immediately after induced hypotension (T(3)), 1 hour after induced hypotension (T(4)), and after supine position at the end of surgery (T(5)). Cerebral desaturation was defined as a reduction in rSO(2) to less than 80% of baseline value for 15 seconds or greater. RESULTS A total of 27 patients were evaluated until the end of this study. The MAP at T(2) was significantly lower than that at T(1). The MAP values at T(3) and T(4) were significantly lower than those at T(1) and T(2). The rSO(2) at T(2) was significantly lower than that at T(1). Unlike the pattern of change in the MAP, there was no additional decrease in rSO(2) at T(3) and T(4). There were 2 patients who had an episode of cerebral desaturation. CONCLUSIONS The beach-chair position combined with induced hypotension significantly decreases rSO(2) in patients undergoing shoulder arthroscopic surgery under general anesthesia. LEVEL OF EVIDENCE Level IV, study of nonconsecutive patients without consistently applied reference gold standard.
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Affiliation(s)
- Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Hudetz JA, Gandhi SD, Iqbal Z, Patterson KM, Pagel PS. Elevated postoperative inflammatory biomarkers are associated with short- and medium-term cognitive dysfunction after coronary artery surgery. J Anesth 2011; 25:1-9. [PMID: 21061037 DOI: 10.1007/s00540-010-1042-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 10/07/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We tested the hypothesis that elevated postoperative interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations are associated with short- and medium-term impairment of cognitive functions in patients after coronary artery surgery using cardiopulmonary bypass. METHODS Eighty-six age- and education-balanced patients ≥55 years of age undergoing elective coronary artery bypass surgery with cardiopulmonary bypass and 28 nonsurgical controls with coronary artery disease were enrolled. Recent verbal and nonverbal memory and executive functions were assessed before surgery and at 1 week and 3 months after surgery using a cognitive test battery. IL-6 concentrations were measured before surgery and 4 h after cardiopulmonary bypass, and CRP concentrations were measured before surgery and at 24 and 72 h after anesthetic induction. Overall cognitive function between high and low biomarker concentration groups was analyzed by the Wilcoxon rank-sum test. RESULTS Recent memory was at least 1 standard deviation (SD) impaired at 1 week and 3 months in the high-CRP compared with low-CRP and in the high-IL-6 compared with low-IL-6 concentration groups. Overall cognitive function was significantly (P = 0.04 and P = 0.01, respectively) different between the high- and low-CRP concentration groups (CRP assayed 24 h after anesthetic induction) at both 1 week and 3 months. Overall cognitive function was also significantly (P = 0.04) different between the high and low-IL-6 concentration groups at 1 week after surgery. CONCLUSION The results suggest that elevated postoperative IL-6 and CRP concentrations are associated with the subsequent development of short- and medium-term impairment of cognitive functions after coronary artery surgery.
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Affiliation(s)
- Judith A Hudetz
- Department of Anesthesiology, Clement J. Zablocki Veterans Administration Medical Center, 5000 W. National Avenue, Milwaukee, WI 53295, USA.
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Postoperative cognitive dysfunction after noncardiac surgery: effects of metabolic syndrome. J Anesth 2011; 25:337-44. [PMID: 21516370 DOI: 10.1007/s00540-011-1137-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/17/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE Vascular risk factors, including metabolic syndrome, are known to contribute to the development of cognitive dysfunction. We tested the hypothesis that patients with metabolic syndrome are more likely to develop cognitive dysfunction after noncardiac surgery. METHODS Age- and education-balanced patients (n = 60) undergoing elective noncardiac surgery with and without metabolic syndrome and 30 nonsurgical controls were enrolled. Recent verbal and nonverbal memory and executive functions were assessed using a psychometric test battery before and 1 month after noncardiac surgery or at a 1-month interval in nonsurgical controls. RESULTS Neurocognitive scores under baseline conditions were similar in surgical patients with versus without metabolic syndrome in all examined cognitive modalities (recent nonverbal and verbal memory, executive functions). Pronounced reductions in tests of verbal memory (delayed story recall, immediate and delayed word list recall) and executive function (backward digit span) were observed in patients with versus without metabolic syndrome after surgery. Overall cognitive performance after surgery was also significantly (P = 0.03) more impaired in patients with versus without metabolic syndrome. The prevalence rate of POCD wasdifferent in the studied groups (17/30 [corrected] and 8/30 in patientswith versus without metabolic syndrome; P < 0.02). CONCLUSIONS The results indicate that cognitive functions were more profoundly impaired in patients with metabolic syndrome undergoing noncardiac surgery compared with their healthier counterparts.
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Hudetz JA, Gandhi SD, Iqbal Z, Patterson KM, Byrne AJ, Warltier DC, Pagel PS. History of Post-traumatic Stress Disorder Is Associated With Impaired Neuropsychometric Performance After Coronary Artery Surgery. J Cardiothorac Vasc Anesth 2010; 24:964-8. [DOI: 10.1053/j.jvca.2010.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW Populations across the world are getting older and requiring more surgery. Elderly patients present unique challenges to the anesthesiologist and anesthesia-care team. This review addresses some concerns when caring for an elderly patient. Specifically, we discuss postoperative cognitive decline (POCD) and postoperative delirium, perioperative beta-blockade and use of newer drugs, as well as older drugs. RECENT FINDINGS POCD has emerged as a new concern for anesthesiologists and their older patients. Several recent studies indicate that POCD is common after noncardiac surgery, with an incidence approaching 30-40% at discharge, although this incidence declines at 3 months. Some data suggest that POCD imparts risk for death. However, there is conflicting evidence. With regard to beta-blocker therapy, there has been growing concern about widespread use of beta-blocker therapy in the perioperative period, especially because such therapy might increase the risk for stroke. SUMMARY Elderly patients require focused diligent care. They are particularly sensitive to the many drugs that are administered in the perioperative period. Recent data suggest that POCD is a real concern, but it is unclear what, if anything, can be done to prevent this complication. Beta-blocker therapy is beneficial in select patients but its widespread use cannot be supported.
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Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Pagel PS. Metabolic syndrome exacerbates short-term postoperative cognitive dysfunction in patients undergoing cardiac surgery: results of a pilot study. J Cardiothorac Vasc Anesth 2010; 25:282-7. [PMID: 20728380 DOI: 10.1053/j.jvca.2010.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors tested the hypothesis that patients with metabolic syndrome are more likely to develop short-term cognitive dysfunction after cardiac surgery with cardiopulmonary bypass. DESIGN A prospective study. SETTING Veterans Affairs medical center. PARTICIPANTS Fifty-six age- and education-balanced patients undergoing elective cardiac surgery with cardiopulmonary bypass (28 patients with and without metabolic syndrome in two separate groups) and 28 nonsurgical controls were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Recent verbal and nonverbal memory and executive functions were assessed using a psychometric test battery before and 1 week after cardiac surgery or at 1-week intervals in nonsurgical controls. Neurocognitive scores under the baseline condition were at least 1 z score (1 standard deviation) worse in surgical patients with compared without metabolic syndrome in all 3 cognitive areas (nonverbal and verbal recent memory and executive functions). Neurocognitive performance further deteriorated after surgery by at least 1 z score on 3 tests in the verbal memory modality (Immediate and Delayed Story Recall and Delayed Word List Recall). Overall cognitive performance (composite z score) after surgery was significantly (p = 0.03) worse in metabolic syndrome patients compared with those who did not have the disorder. CONCLUSIONS The results indicate that short-term cognitive functions were more profoundly impaired in patients with metabolic syndrome undergoing cardiac surgery with cardiopulmonary bypass compared with their healthier counterparts.
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Affiliation(s)
- Judith A Hudetz
- Department of Anesthesiology, Medical College of Wisconsin and Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA.
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Hudetz JA, Hoffmann RG, Patterson KM, Byrne AJ, Iqbal Z, Gandhi SD, Warltier DC, Pagel PS. Preoperative Dispositional Optimism Correlates With a Reduced Incidence of Postoperative Delirium and Recovery of Postoperative Cognitive Function in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2010; 24:560-7. [DOI: 10.1053/j.jvca.2010.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Indexed: 12/12/2022]
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Hudetz JA, Byrne AJ, Patterson KM, Pagel PS, Warltier DC. Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass. Psychol Rep 2009; 105:921-32. [DOI: 10.2466/pr0.105.3.921-932] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.
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Affiliation(s)
| | | | | | - Paul S. Pagel
- Department of Anesthesiology, Medical College of Wisconsin
| | - David C. Warltier
- Zablocki Veterans Administration Medical Center, Milwaukee, Wisconsin
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Hudetz JA, Patterson KM, Byrne AJ, Iqbal Z, Gandhi SD, Warltier DC, Pagel PS. A history of alcohol dependence increases the incidence and severity of postoperative cognitive dysfunction in cardiac surgical patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2725-39. [PMID: 20049218 PMCID: PMC2800057 DOI: 10.3390/ijerph6112725] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/17/2009] [Indexed: 12/12/2022]
Abstract
Postoperative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. We tested the hypothesis that a history of alcohol dependence is associated with an increased incidence and severity of POCD in male patients undergoing cardiac surgery using cardiopulmonary bypass. Recent verbal and nonverbal memory and executive functions were assessed before and one week after surgery in patients with or without a history of alcohol dependence. Cognitive function was significantly reduced after cardiac surgery in patients with versus without a history of alcohol dependence. The results suggest that a history of alcohol dependence increases the incidence and severity of POCD after cardiac surgery.
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Affiliation(s)
- Judith A. Hudetz
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; E-Mails:
(Z.I.);
(S.D.G.);
(D.C.W.);
(P.S.P)
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
| | - Kathleen M. Patterson
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
- Departments of Psychiatry, Behavioral Medicine, and Neurology Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alison J. Byrne
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
| | - Zafar Iqbal
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; E-Mails:
(Z.I.);
(S.D.G.);
(D.C.W.);
(P.S.P)
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
| | - Sweeta D. Gandhi
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; E-Mails:
(Z.I.);
(S.D.G.);
(D.C.W.);
(P.S.P)
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
| | - David C. Warltier
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; E-Mails:
(Z.I.);
(S.D.G.);
(D.C.W.);
(P.S.P)
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
| | - Paul S. Pagel
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; E-Mails:
(Z.I.);
(S.D.G.);
(D.C.W.);
(P.S.P)
- Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA; E-Mails:
(K.M.P.);
(A.J.B.)
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Pain L, Laalou FZ. [Postanesthesia cognitive dysfunction]. Presse Med 2009; 38:1597-606. [PMID: 19786338 DOI: 10.1016/j.lpm.2009.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 11/27/2022] Open
Abstract
The cognitive dysfunctions observed in patients after anesthesia are due not only to the effects of but also to the surgery, the disease requiring surgery, and post-operative treatment. Initial cognitive recovery from anesthetic agents is usually fast, from several hours to several days, but can be delayed by postoperative treatment (analgesia, for example) that have deleterious cognitive effects. During the initial period after surgery, acute impairment of cognitive functions is seen in some patients at risk (major surgery, aged patients, brain sensitivity, or sepsis), specifically transitory (1-3 days in most cases) postoperative delirium. This delirium or confusion requires follow-up at 3 months to check cognitive functions, especially in aged patients. Cohort studies show that cognitive impairment can be objectively identified at one week after surgery with general anesthesia in around 40% of patients, regardless of age. This risk is reduced slightly by the use of loco-regional anesthesia. Cognitive dysfunction is still observed at 3 months after surgery in about 10-15% of patients older than 60 years and in about 6% of younger patients. In patients with a pre-existing cerebral disease with cognitive symptoms, the incidence of long-lasting additional cognitive impairment remains unknown. The mechanisms of this long-term cognitive dysfunction remain to be elucidated.
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Affiliation(s)
- Laure Pain
- Groupe de recherches et d'études sur les répercussions cognitivo-affectives de l'anesthésie, Inserm U666 ; Pôle anesthésie réanimation, CHU de Strasbourg, Faculté de médecine, F-67000 Strasbourg, France.
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Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Hudetz AG, Pagel PS, Warltier DC. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand 2009; 53:864-72. [PMID: 19422355 DOI: 10.1111/j.1399-6576.2009.01978.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Post-operative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. Ketamine exerts neuroprotective effects after cerebral ischemia by anti-excitotoxic and anti-inflammatory mechanisms. We hypothesized that ketamine attenuates POCD in patients undergoing cardiac surgery concomitant with an anti-inflammatory effect. METHODS Patients randomly received placebo (0.9% saline; n=26) or an i.v. bolus of ketamine (0.5 mg/kg; n=26) during anesthetic induction. Anesthesia was maintained with isoflurane and fentanyl. A nonsurgical group (n=26) was also included as control. Recent verbal and nonverbal memory and executive functions were assessed before and 1 week after surgery or a 1-week waiting period for the nonsurgical controls. Serum C-reactive protein (CRP) concentrations were determined before surgery and on the first post-operative day. RESULTS Baseline neurocognitive and depression scores were similar in the placebo, ketamine, and nonsurgical control groups. Cognitive performance after surgery decreased by at least 2 SDs (z-score of 1.96) in 21 patients in the placebo group and only in seven patients in the ketamine group compared with the nonsurgical controls (P<0.001, Fisher's exact test). Cognitive performance was also significantly different between the placebo- and the ketamine-treated groups based on all z-scores (P<0.001, Mann-Whitney U-test). Pre-operative CRP concentrations were similar (P<0.33, Mann-Whitney U-test) in the placebo- and ketamine-treated groups. The post-operative CRP concentration was significantly (P<0.01, Mann-Whitney U-test) lower in the ketamine-treated than in the placebo-treated group. CONCLUSIONS Ketamine attenuates POCD 1 week after cardiac surgery and this effect may be related to the anti-inflammatory action of the drug.
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Affiliation(s)
- J A Hudetz
- Department of Anesthesiology, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI.
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Nitroglycerin- and nicardipine-induced hypotension does not affect cerebral oxygen saturation and postoperative cognitive function in patients undergoing orthognathic surgery. J Oral Maxillofac Surg 2008; 66:2104-9. [PMID: 18848109 DOI: 10.1016/j.joms.2008.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 02/01/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to investigate the influence of nitroglycerin- and nicardipine-induced hypotension on regional cerebral oxygen saturation (rSO(2)) and postoperative cognitive function in patients undergoing orthognathic surgery. PATIENTS AND METHODS Sixty adult patients scheduled for orthognathic surgery were randomly assigned to either the nitroglycerin group (group 1) or nicardipine group (group 2). After induction of anesthesia, hypotension was induced with continuous infusion of nitroglycerin or nicardipine. Mean arterial pressure (MAP), heart rate (HR), and rSO(2) were measured at the following time points: before induction of anesthesia, immediately before commencing induced hypotension, at 30 and 60 minutes after induced hypotension, and immediately before the end of surgery. Cerebral desaturation was defined as a reduction of rSO(2) less than 75% of baseline for > or = 15 seconds. The Mini Mental State Examination (MMSE) was conducted before surgery and then repeated after 1 week. RESULTS Baseline rSO(2) values were similar in the 2 groups. There were no significant differences in rSO(2) values between the 2 groups. Cerebral desaturation was not observed in any of the patients. Both nitroglycerin and nicardipine reduced MAP and increased HR during induced hypotension as compared with the baseline values (P < .05). No differences in MAP and HR during baseline and induced hypotension were observed between the 2 groups. Decreased MMSE scores were not observed in any of the patients. CONCLUSION Cerebral oxygen saturation and postoperative cognitive function were not impaired during nitroglycerin- and nicardipine-induced hypotension in patients undergoing orthognathic surgery.
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Caza N, Taha R, Qi Y, Blaise G. The effects of surgery and anesthesia on memory and cognition. PROGRESS IN BRAIN RESEARCH 2008; 169:409-22. [PMID: 18394490 DOI: 10.1016/s0079-6123(07)00026-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This chapter describes current findings from the research into postoperative cognitive dysfunction (POCD) following cardiac and non-cardiac surgery in older adults. The evidence suggests that a significant proportion of patients show POCD in the early weeks following surgery and anesthesia. Specific domains of cognition are affected, especially memory. Much less evidence supports the presence of POCD several months or years after surgery, suggesting that POCD may be transient. However, several methodological issues make it difficult to compare findings across studies. Increasing age is among the most consistently reported patient-related risk factor. Other factors more directly related to the surgery and anesthesia are likely to contribute to the pathogenesis of POCD, including inflammatory processes triggered by the surgical procedure. Animal studies have provided valuable findings otherwise not possible in human studies; these include a correlation between the inflammatory response in the hippocampus and the development of POCD in rodents.
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Affiliation(s)
- Nicole Caza
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, 4565 chemin Queen-Mary, Montréal, QC H3W 1W5, Canada.
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