Incidence Of Postoperative Cognitive Dysfunction In Patients Research Articles

Effects of intraoperative body temperature, blood pressure, cerebral tissue oxygenation, and anesthesia type on postoperative cognitive functions in geriatric arthroplasty surgery for hip fracture.

This study aimed to explore the effects of cerebral oxygenation, body temperature, hemodynamic changes, and anesthesia type on postoperative cognitive dysfunction (POCD) in geriatric patients undergoing hip fracture surgery. One hundred five elderly patients (59 males, 46 females; mean age: 76.7±8.8 years; range, 65 to 95 years) who were scheduled for hip fracture surgery under general or spinal anesthesia between March 2021 and March 2023 were enrolled in the prospective observational study. The cognitive functions were evaluated using the Mini-Mental State Examination (MMSE). Postoperative MMSE values <24 were considered indicative of POCD. Cerebral oxygenation was evaluated before and during the operation using near-infrared spectroscopy (NIRS), and body temperature was measured using a tympanic thermometer, with values <36℃ considered hypothermia. The relationship between decreases in blood pressure ≥30% and POCD was investigated. The relationship between decreases in NIRS of 25% and POCD was also investigated. Postoperative cognitive dysfunction was observed in 29 (27.25%) of the 105 patients. The MMSE value was 24 in 67.06% of 29 patients, and all these patients developed POCD. The incidence of POCD in patients with a preoperative MMSE1 score of 30 was 12.30% (p=0.001). No relationship was identified between MMSE changes and anesthesia type, hypotension, and decreases in the NIRS (p=0.439, p=0.399). Hypothermia was found to be significantly related to POCD (p=0.013). The degree of hypothermia decreased the postoperative MMSE value at different rates. A 1°C body temperature decrease caused a 16.7%, 44.4%, and 50% decrease in MMSE scores of one, one, and two patients, respectively. Hypothermia was found to be significantly related to POCD. The same degree of hypothermia caused different MMSE changes. Since the number of patients with POCD was very low, the effect of amounts of body temperature changes on clinically significant MMSE changes could not be supported by logistic regression. The preoperative MMSE values, MMSE change rates, and age were found to be effective in POCD. Maintaining the body temperature throughout the operation will ensure the preservation of postoperative cognitive functions.

492 Periprocedural Polypharmacy in Lumbar Fusions Performed Under Spinal Anesthesia Compared to General Anesthesia

INTRODUCTION: Lumbar spinal surgery is most often performed under general endotracheal anesthesia (GEA), however spinal anesthesia (SA) is a safe and effective alternative. Postoperative cognitive dysfunction (POCD) is a complication of GEA and the risk of POCD is associated with anesthetic modality and perioperative polypharmacy. Despite the many benefits of SA described in the literature, its efficacy in decreasing polypharmacy has not yet been determined. METHODS: Demographic and procedural data of 424 patients undergoing single TLIF via GEA (n = 186) and SA (n = 238) were extracted from our institution’s electronic medical record. We investigated perioperative medication types, number of intraoperative hypotensive episodes, vasopressor requirement, and overall number of perioperative medications used between the two patient groups. RESULTS: The number of perioperative medications differed significantly between the two cohorts with the SA cohort receiving a mean of 4.5 medications and the GEA cohort receiving a mean of 10.5 medications (p &lt; 0.0001).This reduction in perioperative medications remained significant after a multivariable analysis to control for confounders (p &lt; 0.001 for all variables). Use of vasopressors was significantly reduced in the SA cohort (p &lt; 0.001), which coincided with a significant reduction in hypotensive episodes in the SA cohort (p &lt; 0.001). Patients undergoing TLIF via GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (OR = 3.62, 95% CI [2.38-5.49]). CONCLUSIONS: Spinal anesthesia is associated with a significant decrease in perioperative medications, including lower vasopressor requirements. We postulate that SA may confer superior intraoperative hemodynamic stability which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs.

Correlation of S100B level and postoperative cognitive dysfunction (POCD) events among patients with ear, nose and throat (ENT) surgeries with controlled hypotension

Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension. Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery. Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p&lt;0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not. Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.

Periprocedural Polypharmacy in Lumbar Fusions Performed Under Spinal Anesthesia Compared With General Anesthesia.

Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Although POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others. To determine whether SA reduced polypharmacy compared with GEA in patients undergoing transforaminal lumbar interbody fusion (TLIF). Demographic and procedural data of 424 consecutive TLIF patients were extracted retrospectively. Patients undergoing single-level TLIF through GEA (n = 186) or SA (n = 238) were enrolled into our database. Perioperative medications, excluding antibiotic prophylaxis and local anesthetics, were classified into various categories. Patients in the SA cohort received a mean of 4.5 medications vs a mean of 10.5 medications in the GEA cohort ( P < .0001). This reduction in perioperative medications remained significant after a multivariate analysis to control for confounders ( P < .001 for all variables). The use of vasopressors was significantly reduced in the SA cohort ( P < .001), which coincided with a significant reduction in hypotensive episodes ( P < .001). Patients undergoing TLIF through GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (odds ratio = 3.62, 95% CI [2.38-5.49]). Spinal anesthesia is associated with a significant decrease in perioperative medications and may confer superior intraoperative hemodynamic stability, which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs, although this requires further study.

The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery: a randomized trial.

In video-assisted thoracoscopic surgery (VATS), intubated anesthesia may affect cerebral oxygen balance and postoperative cognitive dysfunction (POCD). To avoid complications associated with intubated anesthesia, tubeless strategies have been proposed in recent years, but its effect on cerebral oxygen balance and POCD is still unclear. This prospective study compared the cerebral oxygen saturation and the incidence of POCD in patients undergoing VATS anesthetized with tubeless anesthesia vs. intubated anesthesia. A total of 60 patients with American Society of Anesthesiologists Standard (ASA) grade I-II who planned to undergo VATS at The First People's Hospital of Yunnan Province between May and October 2021 were selected and divided into non-intubated spontaneous ventilation group (SV group) or intubated mechanical ventilation group (MV group) by random number method. The primary outcome included the incidence of POCD and Mini-Mental State Examination (MMSE) on the 1st before operation and the 4th, 7th, 14th, and 30th day postoperatively, and cerebral oxygen saturation during surgery. Other outcomes of interest include respiratory and hemodynamic parameters, serum concentration of cognitive function related proteins [S100β, interleukin (IL)-6, IL-1β, and tumor necrosis factor α (TNF-α)], inflammatory cell counts, perioperative adverse events (arrhythmia, hypoxemia, asphyxia, etc.), postoperative pain scores, etc. The incidence of hypercapnia in the SV group was significantly higher than in the MV group (P<0.001). Cerebral oxygen saturation at intraoperative was significantly higher than that in MV group (P<0.01). There was no significant difference in the incidence of POCD and the expression of cognitive function related proteins between the two groups (P>0.05). Leukocyte and neutrophil counts were significantly higher in the MV group after operation (P<0.05), whilst compared to the MV group, the SV group showed shorter postoperative recovery time, rest time before the first out of bed activity, chest tube duration, as well as less drainage volume of the chest tube and postoperative sore throat rarely occurred (P<0.05). Tubeless VATS can increase the incidence of hypercapnia and intraoperative cerebral oxygen saturation, but has no statistically significant difference in the incidence of POCD. In addition, tubeless anesthesia reduces systemic inflammatory, promotes the early postoperative mobilization, and accelerates the postoperative rehabilitation of patients. Chinese Clinical Trial Registry ChiCTR2100042381.

Systematic review and meta-analysis of the prognostic value of Narcotrend monitoring of different depths of anesthesia and different Bispectral Index (BIS) values for cognitive dysfunction after tumor surgery in elderly patients.

BackgroundTo study the effect of Narcotrend monitoring on the incidence of early postoperative cognitive dysfunction (POCD) under different Bispectral Index (BIS) conditions and the effect of different depths of anesthesia on the incidence of POCD.MethodsWe performed a literature search of the PubMed, Embase, OVID (database system made by Ovid Technologies, USA), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Chinese Sci-tech Journals Database, Wanfang Data, etc. from the date of establishment of the database until December 31, 2020.ResultsIn the end, eighty articles were included, with a total of 714 patients. The meta-analysis results showed that four articles (255 patients) compared the state of deep anesthesia (BIS 30–40) with conventional anesthesia (BIS 40–60 earlier) after POCD. Also, the incidence of POCD on the first day after deep anesthesia [Narcotrend stage (NTS): negative correlation is currently the most appropriate egg description; Nd can subdivide the original electroencephalogram (EEG) into six stages 15 levels (Nd Sg, NTS), or A (state of wakefulness), state B0–B2 (sedated state), state C0–C2 (light anesthetic state), state D0–D2 (general anesthesia), state E0–E2 (deep anesthesia state), and state F0–F2 (burst suppression state)] was significantly lower than that of conventional anesthesia (NTS D0–D1) [odds ratio (OR) =0.21, 95% confidence interval (CI): 0.13–0.35, P<0.00001]. Moreover, the incidence of POCD in deep anesthesia (NTS E1) at 7 days after surgery was significantly lower than that of conventional anesthesia (NTS D0) (OR =0.45, 95% CI: 0.23–0.91, P=0.03), while the incidence of POCD 7 days after NTS D2 in conventional anesthesia was significantly lower than that of NTS D0 (OR =0.42, 95% CI: 0.24–0.71, P=0.001).DiscussionsPOCDs are thought to be the result of a combination of physical defects and precipitating factors in patients with their own physical impairments, and despite potential adverse effects, there is currently no consensus on the incidence of POCDs in patients with tumor, current risk factors, causes, and prevention strategies. Moreover, the level of evidence is low, and the deviation between different studies cannot be ruled out.

Effects of General Anesthesia Combined with Epidural Anesthesia on Cognitive Dysfunction and Inflammatory Markers of Patients after Surgery for Esophageal Cancer: A Randomised Controlled Trial.

To evaluate the impact of general anesthesia (GA) combined with epidural anesthesia (GAEA) on postoperative cognitive dysfunction (POCD) and inflammatory markers in patients with esophageal cancer (EC). Study Design: A randomised controlled trial. Department of Anesthesiology, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan Province, China, from August 2019 to April 2020. SPSS was used to randomly divide 142 cases into two groups, namely: the GA (n=71) and GAEA (n=71) categories. 128 candidates were used in this study. Cognitive function and the levels of interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis markers α (TNF-α) in serum were evaluated at baseline, 1, 3 and 7 days after operation by Montreal Cognitive Assessment (MoCA) and enzyme-linked immunosorbent assay (ELISA), respectively. Pearson correlation analysis was used to assess the interrelationships between MoCA score and inflammatory markers levels. Compared to the GA group (n=64), the GAEA category (n=64) showed significantly higher MoCA score on 1 day and 3 days postoperatively (all p <0.05). IL-6, IL-8 and TNF-α in the GA group were significantly increased on 1, 3 and 7 days after surgery (all p <0.05). Pearson correlation analysis indicated that the three inflammatory markers were inversely correlated with cognitive function score (all p <0.05). The postoperative adverse events between the two groups were comparable (all p >0.05). Combining general and epidural anesthesia may reduce the incidence of POCD in patients undergoing esophagectomy by suppressing inflammatory response. Key Words: General anesthesia, Epidural anesthesia, Esophageal cancer, Postoperative cognitive dysfunction, Inflammatory markers.

Bispectral-Based Ultrasound Image Restoration Algorithm for Neurological Disorders Analysis in Patients Anesthetized with Sevoflurane

The aim of this work was to investigate preventive effect of dexmedetomidine combined with sevoflurane on neurological disorders in liver cancer patients during postoperative recovery under the ultrasound image restoration (UIR) algorithm. A blind deconvolution medical UIR algorithm was established in this study. The patients anesthetized with sevoflurane for liver cancer surgery were rolled into an experimental group (group A) (dexmedetomidine treatment before surgery) and a control group (group B) (normal saline treatment before surgery). They were monitored routinely before, during, and after surgery, and immune and liver functions of patients were observed before and after surgery. Besides, their cognitive function and adverse reactions were assessed after surgery. Results showed that patients from group A had smaller fluctuation in average arterial blood pressure and heart rate, but their bispectral index (BIS) increased obviously after surgery in contrast to those of group B ( P &lt; 0.05 ). Moreover, changes of immune and liver functions in patients from group A decreased sharply compared with group B ( P &lt; 0.05 ). The postoperative minimental state examination (MoCA) score of patients from group A was 27.51 ± 2.02, while the score of group B was 25.79 ± 2.35. The postoperative (MoCA) score of group A was markedly higher than the score of group B, and the difference was statistically obvious ( P &lt; 0.05 ). Besides, the incidence of postoperative cognitive dysfunction (POCD) in patients from group A and B was 12.91% and 32.26% in turn. The incidence of POCD in patients from group A was sharply lower than the incidence of group B ( P &lt; 0.05 ). In addition, the total incidence of adverse reactions in patients from group A was 6.45%, which was significantly lower than the 22.58% of group B, and the difference was statistically substantial ( P &lt; 0.05 ). In summary, dexmedetomidine combined with sevoflurane could effectively reduce POCD and promote systemic circulation recovery, which had clinical application value.

Early postoperative cognitive dysfunction after simultaneous coronary artery bypass grafting and carotid endarterectomy

Abstract Purpose To assess cognitive status after simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEE). Material &amp; methods. Changes in cognitive status and the incidence of POCD were evaluated in the early postoperative period after simultaneous CABG and CEE. 53 patients with polyvascular disease (PolyVD) undergoing CABG and CEE were included in the study. Patients were assigned to two groups. 25 patients without mild cognitive impairment (MCI), the mean age of 64.3±7.9 years, were included in Group 1 and 28 patients with MCI, the mean age of 65.3±6.75 years, were included in Group 2. Neuropsychological testing was performed on days 2 before surgery and on days 7 after surgery using the psycho-physiological testing software “Status PF”. Attention was assessed with the Bourdon's test or proofreading test. Memory was estimated with the 10 numbers memorizing test, 10 words memorizing test, and 10 syllables memorizing test. The assessment of neurodynamics included the measurement of the complex visual-motor reaction time (VMRT), brain performance (BP), and functional mobility of the nervous processes (FMNP). The presence of POCD was estimated as a 20% decline on 20% of the tests. A reference range for neuropsychological indicators (13 indicators of the test battery) was set at the intervals corresponding to the ranges between the quartiles [Q25; Q75] in healthy people. Thus, cognitive status scale includes low cognitive status with the values ranging from 0 to 0.34, below the average - from 0.35 to 0.51, the average - from 0.52 to 0.7, and high cognitive status &amp;gt;0.7 to 1.0. Early postoperative cognitive dysfunction (POCD) was diagnosed as a 20% decline in memory, attention, and neurodynamics from the baseline on 20% of the tests passed. Statistical analysis was performed using the “Advanced” software package. Results At baseline, cognitive status in patients without MCI was below the average (0.38±0.2), whereas in MCI patients it was lower by 32% and corresponded to low (0.26±0.1; p=0.03). Cognitive status did not differ significantly between both groups in the postoperative period, but a trend towards its decrease was determined (0.34±0.2 vs. 0.27±0.13, p&amp;gt;0.5). However, the incidence of early POCD in patients without MCI was 14 (56%), and in patients with MCI - 20 (71%) patients. Conclusion At baseline, patients with PolyVD, regardless of the presence of MCI, according to the results of the comprehensive examination, showed low and below the average cognitive status. Simultaneous CABG and CEE does not prevent the deterioration of cognitive functions in patients with PolyVD in the early postoperative period. Patients with PolyVD undergoing myocardial and brain revascularization have a high risk of worsening cognitive disorders and need to individual approach to make a reasonable choice of the optimal surgical strategy. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Institute

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting.

We assessed the relationship between red blodd cell distribution width (RDW) and postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG) in patients who usually had obvious hemodynamic changes. We enrolled 362 coronary heart disease patients who received CABG. POCD was assessed through neuropsychological examination at 21 days after operation. Demographics, history of diseases, blood biochemical parameters and perioperative data were collected. The receiver operating characteristic (ROC) curve was used to find the best cut-off value of RDW for diagnosis of POCD. Logistic regression was used to explore the relationship between RDW and POCD. The 21-day incidence of POCD in patients receiving CABG was 27.1% (98/362). The RDW of POCD patients was significantly higher than in the non-POCD patients (17.4 vs. 13.2). The sensitivity and specificity of RDW for predicting POCD were 82.7 and 64.8%, respectively. The POCD patients also tended to be older and had higher fasting plasma glucose, hypersensitive c-reactive protein, tumor necrosis factor-α, white blood cell levels and longer surgery time. No significant differences were found in other parameters. The 21-day neuropsychological test results were better in the POCD patients than the non-POCD patients. After adjustment of potential factors, the preoperative high RDW was still associated with an increased risk of POCD (odds ratio (OR) = 2.52, 95% confidence interval (CI): 1.28–4.31). Our study indicates that preoperative RDW is significantly elevated in POCD patients receiving CABG. The elevated preoperative RDW is associated with an increased risk of POCD and preoperative RDW can be an independent predictor of POCD.

Effect of General and Non-general Anesthesia on Postoperative Cognitive Dysfunction.

ABATRACT Controversy exists in the effect of general anesthesia and non-general anesthesia on postoperative cognitive dysfunction (POCD). The authors aimed to perform this systematic review to comprehensively assess the effect of general anesthesia or non-general anesthesia on POCD. Relative studies from the online literature database were retrieved. Seven studies with 1,031 patients were included. Odds ratio and 95% confidence interval were calculated. The results showed that the POCD incidence was significantly lower in the patients underwent non-general anesthesia than those underwent general anesthesia in one and three days after surgery (p<0.05). However, no remarkable difference existed between the two anesthesia in seven days and three months after surgery (p>0.05). In conclusion, when compared with the non-general anesthesia, general anesthesia increases the incidence of POCD in patients within three days after surgery, but makes no difference after seven days. It suggests that early intervention should be conducted on patients undergoing general anesthesia. Key Words: General anesthesia, Postoperative cognitive dysfunction, Meta-analysis.

Effects of different analgesia regimens on early post-operative cognitive dysfunction in elderly patients undergoing radical resection of cervical carcinoma.

This study was designed to compare the effects of epidural and intravenous analgesia on early post-operative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of cervical cancer. For this purpose, 74 patients aged 60-78 years [body mass index (BMI), 18-25 kg/m2; American Society of Anesthesiologists (ASA) classification score of I-III) undergoing radical resection of cervical cancer were divided into the epidural group (group E) and parenteral group (group P) groups (37 patients in each group). All patients underwent their surgical procedures under epidural anesthesia and intravenously-delivered general anesthesia. Patient-controlled analgesia (PCA) was supplied for 72 h after the surgery. Epidural analgesia was provided for the patients in group E and intravenous analgesia was provide for those in group P. General patient information was recorded and peripheral blood neutrophil counts, C-reactive protein (CRP) levels and interleukin (IL)-6 concentrations were measured immediately prior to the surgery (T0), and at 24, 48 and 72 h after the procedure (T1, T2 and T3, respectively). Visual analog scale (VAS) scores were also recorded at T1, T2 and T3, and the mini-mental state evaluation (MMSE) scores at T0, T1, T2, and T3 were calculated. Patients were diagnosed as having POCD according to their MMSE score differences between the peri-operative and post-operative values. The results revealed that the levels of CRP and IL-6 significantly increased in both groups after the surgery (T1-3). However, the CRP and IL-6 levels in group E were significantly lower than those in group P at all time points examined (P<0.05). The VAS scores in group E at T1, T2 and T3 were significantly lower than those in group P (P<0.05). Finally, the incidence of POCD in group E was significantly lower than that in group P (P<0.05). On the whole, the post-operative epidural analgesia reduced the systemic inflammatory response, the perceived pain, and the incidence of POCD in patients undergoing radical resection of cervical cancer, when compared with the effects of intravenous analgesia.

The effect of electroacupuncture preconditioning on cognitive impairments following knee replacement among elderly: A randomized controlled trial

ObjectiveTo investigate if electroacupuncture (EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction (POCD) following knee replacement and its safety among elderly. MethodsTotally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy (Streitberger Placebo-needle). In both groups, Tou sanshen (头三神) acupoints, including Sìshéncōng (四神聪EX-HN1), Shéntíng (神庭 GV24), and bilateral Běnshén (本神GB13) were adopted as the main acupoints, while Bǎihuì (百会GV20), bilateral Hégǔ (合谷LI4), and bilateral Tàichōng (太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of Mini-Mental State Examination (MMSE), and levels of serum inflammatory cytokines including interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded. Results(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ± 0.97 to 27.10 ± 1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25 (all ?P < 0.05), and this trend continued until postoperative 72 h (at postoperative 72 h, MMSE global scores in treatment group was 26.53 ± 2.26 versus 24.79 ± 3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h (P < 0.05). (2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ± 5.51 to 73.13 ± 2.32 at postoperative 24 h and reached 83.17 ± 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 ± 5.83 to 91.10 ± 3.55 at postoperative 24 h and reached 111.93 ± 9.18 at postoperative 72 h; TNF-α in treatment group increased from 51.27 ± 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ± 7.48 to 116.37 ± 3.14 at postoperative 24 h and reached 121.40 ± 3.68 at postoperative 72 h (both ?P < 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant (P < 0.05). Statistical difference in level of S100-β was not observed (P > 0.05). (3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups (P > 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h (POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00% in control group; POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group). (4) No serious adverse events were reported in this trial. No one dropped out from this trial. ConclusionEA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.

Postoperative cognitive dysfunction after sevoflurane or propofol general anaesthesia in combination with spinal anaesthesia for hip arthroplasty.

It is unknown if the type of general anaesthetic used for maintenance of anaesthesia affects the incidence of postoperative cognitive dysfunction (POCD). The aim of this study was to compare the incidence of POCD in patients administered either sevoflurane or propofol for maintenance of anaesthesia during total hip replacement surgery. Following administration of a spinal anaesthetic, patients received either sevoflurane (n=121) or propofol (n=171) at the discretion of the anaesthetist for maintenance of general anaesthesia to maintain the processed electroencephalogram (bispectral index, BIS) under 60. POCD was assessed postoperatively at day 7, three months, and 12 months using a neurocognitive test battery. There was no statistically significant difference between the incidence of POCD at any timepoint with sevoflurane compared to propofol. The mean BIS was significantly lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [standard deviation, SD 7.5] in the sevoflurane group versus 53.7 [SD 8.1] in the propofol group, <i>P</i>=0.0001). However, there was no statistically significant association between intraoperative BIS level and the incidence of POCD at any timepoint. Our results suggest that the incidence of POCD is not strongly influenced by the type of anaesthesia used in elderly patients.

Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial.

One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery. There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD. Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD. No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. ( UMIN 000002826).

Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction (POCD)?

Delirium is a complex neuropsychiatric disorder that has an adverse impact on CNS function. Abnormal fluctuation of melatonin secretion occurs in the postoperative delirium (POD) in elderly patients. POD is strongly associated with early postoperative cognitive dysfunction (POCD). The aim of this study is to test if significant fluctuation of melatonin secretion perioperatively might indicates POCD.A total of 97 patients, ages 65–80 years, scheduled for major orthopedic surgery or abdominal surgery which was expected to last more than 2 h, were consecutively recruited into this study. Neuropsychological evaluation was performed 1 d before and one week after surgery. Morning urine samples were collected on the day of surgery and on days 1, 2 and 7 after surgery. The 6-SMT/creatinine ratio (M/C ratio) was employed to give an objective estimate of urine 6-SMT concentration. Ultimately, 95 patients completed assessments and were included in the analysis. POCD was found in 30 patients (31.6%) at 1 week after operation. There was significant fluctuation in urinary 6-SMT in 39 of the 95 patients (as evidenced by urinary 6-SMT levels increased or decreased by more than twofold compared with their preoperative baseline). Fluctuations in 6-SMT levels occurred on different days and in some patients lasted for more than 1 d. The incidence of POCD in patients with 6-SMT fluctuation was significantly higher (p < 0.01). The results indicate that in the first week after major noncardiac surgery, POCD occurs in a significant proportion of people, and is linked to fluctuations in endogenous melatonin levels. Measurement of urinary 6-SMT during the perioperative period may assist the diagnosis of POCD.

Increase of beta-amyloid and C-reactive protein in liver transplant recipients with postoperative cognitive dysfunction

Postoperative cognitive dysfunction (POCD) is an adverse condition characterized by declined cognitive functions following surgeries and anesthesia. POCD has been associated with increased hospital stay and mortality. There are histological similarities to Alzheimer's disease. Most early studies were conducted in patients receiving cardiac surgery. Since there is no information about POCD in liver transplant recipients, we measured the incidence of POCD in patients after liver transplantation and examined the correlation between neurological dysfunction and biological markers of dementia-based diseases. We studied 25 patients who had a liver transplan-tation between July 2008 and February 2009. Patients with prior encephalopathy or risk factors associated with the development of POCD were excluded from the study. Five validated neuropsychiatric tests were used for diagnosis. The diagnosis was based on one standard deviation decline in two of the five neuropsychiatric tests. The correlation between patient variables and the development of POCD was examined. Serum levels of beta-amyloid and C-reactive protein were measured by standard ELISA and compared between patients with and without POCD. POCD was present in 11 (44%) of the 25 patients. Patients with POCD had significantly higher MELD scores, were more often Child-Pugh class C and received more blood transfusion during surgery. The serum beta-amyloid protein and C-reactive protein concentrations were significantly increased at 24 hours after surgery in the POCD group. The incidence of POCD in our group of liver transplant patients was greater than that reported in other surgical patients. The increase in the serum biomarkers of dementia in the POCD patients supports the hypothesis that chronic cognitive defects are due to a process similar to that seen in Alzheimer's disease.

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly