Abstract
BackgroundSurgery and anesthesia have been linked to postoperative cognitive disturbance and increased risk of Alzheimer’s disease. It is not clear by which mechanisms this increased risk for cognitive disease is mediated. Further, amyloid β production has been suggested to depend on the sleep-wake cycle and neuronal activity. The aim of the present study was to examine if cerebrospinal fluid (CSF) concentrations of a number of biomarkers for Alzheimer’s disease-related processes, including amyloid β, neuronal injury, and inflammation, changed over time during intravenous anesthesia in surgical patients.MethodsWe included patients scheduled for hysterectomy via laparotomy during general anesthesia with intravenous propofol and remifentanil. CSF samples were obtained before, during, and after surgery (5 h after induction) and tested for 27 biomarkers. Changes over time were tested with linear mixed effects models.ResultsA total of 22 patients, all females, were included. The mean age was 50 years (± 9 SD). The mean duration of the anesthesia was 145 min (± 40 SD).Interleukin (IL)-6, IL-8, monocyte chemoattractant protein 1, and vascular endothelial growth factor A increased over time. IL-15 and IL-7 decreased slightly over time. Macrophage inflammatory protein 1β and placental growth factor also changed significantly. There were no significant effects on amyloid β (Aβ) or tau biomarkers.ConclusionsSurgery and general anesthesia with intravenous propofol and remifentanil induce, during and in the short term after the procedure, a neuroinflammatory response which is dominated by monocyte attractants, without biomarker signs of the effects on Alzheimer’s disease pathology or neuronal injury.
Highlights
Surgery and anesthesia have been linked to postoperative cognitive disturbance and increased risk of Alzheimer’s disease
The aim of the present study was to analyze cerebrospinal fluid (CSF) analytes related to amyloid β (Aβ) and tau metabolism, neuronal injury, and inflammation before, during, and after intravenous anesthesia in a patient clientele without known neurological disease or impairment, to determine which neurochemical pathways that are preferentially affected by surgery and intravenous anesthesia
Our findings show that intravenous anesthesia and surgery have effects on CNS inflammation, but we could not show effects on neuronal injury biomarkers or biomarkers reflecting the core Alzheimer’s disease (AD) pathologies Aβ and tau
Summary
Surgery and anesthesia have been linked to postoperative cognitive disturbance and increased risk of Alzheimer’s disease. Surgery and anesthesia have been linked to postoperative cognitive disturbance and to increased risk of future incidence of Alzheimer’s disease (AD) [1]. It is not clear by which mechanism this possible increased risk for AD is mediated. AD is believed to be caused by the accumulation of aggregated amyloid β (Aβ) peptides and Both in vitro and animal studies indicate that anesthetics might affect the neurochemical pathways of AD [5], but few studies have tested this in humans, especially when using intravenous anesthetics. One recent small study found an increase in several biomarkers for inflammation (such as Interleukin (IL)-6 and IL-8) associated with intravenous anesthesia and surgery in humans [13]
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