Postoperative Cognitive Dysfunction In Patients Research Articles

The role of quantitative electroencephalography in the diagnosis of postoperative cerebral consequences in patients with cardiovascular pathology who underwent cardiac surgery using artificial circulation. Importance for oncology (literature review)

Currently, special attention of researchers is attracted to the problem of diagnosing postoperative brain damage and cognitive impairment in patients with cardiovascular pathology after cardiac surgery without/under conditions of artificial circulation (AC). The main method of assessing the functional state of the brain is quantitative electroencephalography (EEG). Because of cardiovascular and oncological pathology could persist in one patient it is actual simultaneous cardial and oncological surgery under EEG monitoring.Objective: based on the literature data, to find out the role of EEG in diagnosis of cerebral complications in patients with cardiovascular pathology after cardiac surgery without /under conditions of AC.Methods. We found and analyzed data in specialized medical data base Pubmed, Scopus, Web of Science about EEG methods in patients after heart bypass with/without AC from 1980 to 2023 years.Results. The quantitative EEG is very important for early diagnosis and prognosis for cerebral ischemia, epileptiform activity, postoperative cognitive dysfunction in patients with coronary heart disease (CHD) after coronary artery bypass with/without AC. However, the studies did not included patients with oncopathology, people over 70 years of age. It opens possibilities for early diagnosis of central nervous system functional condition in patients with lung cancer and cardiovascular disorders in simultaneous (concomitant heart and lung with/without AC) surgery. It will help a correction of complications in time and a development of guided rehabilitation

Markers of brain injury in patients with aneurysmal subarachnoid hemorrhage

The aim of the study was to investigate the correlation of serum changes and markers of brain injury (BI) in cerebrospinal fluid (CSF) with postoperative cognitive dysfunction (POCD) in patients with cerebral aneurysmal subarachnoid haemorrhage (aSAH). 120 patients diagnosed with aSAH were included. 3 months after surgery, these patients were divided into a normal cognition group and a cognitive dysfunction (CD) group relying on the Montreal Cognitive Assessment (MoCA) Scale. The correlations were analysed between the serological changes and the levels of BI markers, such as neurofilament-light (NF-L) protein, Ubiquitin C-terminal hydrolase L1(UCH-L1), Glial Fibrillary Acidic Protein (GFAP), and neuron specific enolase (NSE) in patients after surgery. Hunt-Hess grading standard was employed to determine the severity of aSAH in patients. The mean values of NF-L, UCH-L1, GFAP, and NSE were (8.2 ± 4.3) pg/mL, (0.7 ± 0.3) ng/mL, (2.2 ± 0.4) ng/mL, and (48.5 ± 10.9) ng/mL in patients with severe aSAH, which were remarkably higher than those in patients with mild aSAH [(3.5 ± 0.7) pg/mL, (0.5 ± 0.2) ng/mL, (1.3 ± 0.7) ng/mL, (30.7 ± 8.2) ng/mL]. The sensitivity, specificity, and accuracy of the combined prediction of four detections for POCD were 90.80%, 84.20%, and 82.80%, respectively, which were greatly higher than those of four independent predictions (P < 0.05). The combined prediction effect of the four items, with the area under the curve (AUC) of 0.938 and the 95% confidence interval (CI) of 0.851-0.926. BI markers NF-L, UCH-L1, GFAP, and NSE could be utilized as predictors of POCD in patients with aSAH, deserving a reference value.

The role of dexmedetomidine administered via intravenous infusion as adjunctive therapy to mitigate postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing regional anesthesia: a meta-analysis of randomized controlled trials

Study objectiveThis meta-analysis aimed to assess whether continuous intravenous administration of DEX during surgery can be part of the measures to prevent the onset of postoperative delirium and postoperative cognitive dysfunction in elderly individuals following regional anesthesia.MethodsWe searched the databases of PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure (by June 1, 2023) for all available randomized controlled trials assessing whether intravenous application of dexmedetomidine can help with postoperative delirium and postoperative cognitive dysfunction in the elderly with regional anesthesia. Subsequently, we carried out statistical analysis and graphing using Review Manager software (RevMan version 5.4.1) and STATA software (Version 12.0).Main resultsWithin the scope of this meta-analysis, a total of 18 randomized controlled trials were included. Among them, 10 trials aimed to assess the incidence of postoperative delirium as the primary outcome, while the primary focus of the other 8 trials was on the incidence of postoperative cognitive dysfunction. The collective evidence from these 10 studies consistently supports a positive relationship between the intravenous administration of dexmedetomidine and a decreased risk of postoperative delirium (RR: 0.48; 95%CI: 0.37 to 0.63, p < 0.00001, I2 = 0%). The 8 literature articles and experiments evaluating postoperative cognitive dysfunction showed that continuous intravenous infusion of dexmedetomidine during the entire surgical procedure exhibited a positive preventive effect on cognitive dysfunction among the elderly population with no obvious heterogeneity (RR: 0.35; 95%CI: 0.25 to 0.49,p < 0.00001, I2 = 0%).ConclusionAdministering dexmedetomidine intravenously during surgery can potentially play a significant role in preventing postoperative delirium and postoperative cognitive dysfunction in patients older than 60 years with regional anesthesia according to this meta-analysis.

Single-Photon Emission Computed Tomography in the Diagnosis of Early Postoperative Cognitive Dysfunction After Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting

Objective: to study the contribution of regional cerebral blood flow (rCBF) indicators to the diagnosis of early postoperative cognitive dysfunction (POCD) in patients with multifocal atherosclerosis (MFA) with heart and brain revascularization.Material and methods. The study involved 45 patients with MFA of coronary and precerebral arteries. We analyzed patients’ cognitive indicators and conducted brain scintigraphy before and after revascularization. The criteria for inclusion in the study were: scheduled combined revascularization of coronary and precerebral arteries; signed informed consent to participate in the study. Criteria for exclusion were: refusal to participate in the study, diseases that would prevent examination. The study of cognitive functions was performed using flow was assessed by single-photon emission computed tomography using lipophilic radiopharmaceutical 99mTc-HMPAO “Ceretec”.Results. The frequency of early POCD in the isolated coronary artery bypass grafting (CABG) group was 73.3%, in the combined carotid endarterectomy (СEA) and CABG group it was 72.5% (p ˃ 0.05). The rCBF index in the isolated CABG group compared with the combined СEA and CABG group was higher in the right and left temporal lobes (p = 0.01 and p = 0.04), in the right frontal lobe (p = 0.03), right parietal lobe (p = 0.005), and in the right and left occipital lobes (p = 0.03 and p = 0.03). In the postoperative period, in the isolated CABG group, right parietal lobe perfusion (p = 0.01), and right and left occipital lobe perfusion (p = 0.01 and p = 0.01) decreased compared to the baseline values. In the combined СEA and CABG group, in the early postoperative period, cerebral perfusion did not change significantly. Right parietal lobe perfusion was higher in the isolated CABG group compared with the combined CABG and СEA group (p = 0.04). The greatest contribution to the development of early POCD in patients after isolated CABG was made by the left temporal lobe perfusion (p = 0.025), in patients after combined CABG and СEA – by the right parietal lobe perfusion (p = 0.04) in the early postoperative period.Conclusion. Assessment of cerebral perfusion in patients before and after surgery can be used to identify areas affected during surgery, as a method for monitoring the safety of procedure, and as an assessment of the preventive methods against POCD.

Effects of parecoxib on postoperative cognitive dysfunction and serum levels of NSE and S100β in elderly patients undergoing surgery.

To investigate the effects of parecoxib on postoperative cognitive dysfunction, and serum levels of neuron-specific enolase (NSE) and S100β protein (S100β) in elderly patients undergoing surgery. The retrospective cohort study method was used to collect the clinical data of 94 elderly patients who underwent elective orthopedic and general anesthesia surgery in our hospital from September 2020 to February 2022. 94 patients were divided into the control group (47 cases) and the study group (47 cases), according to different intervention methods. In the study group, 40 mg of parecoxib was injected intravenously into patients 30 min before the induction of anesthesia, and the patients in the control group were given the same dose of normal saline intravenously before the operation. The basic clinical data of the patients were collected. The levels of the indexes before operation and 6 hours after operation were compared between the two groups, including the Montreal Cognitive Scale (MoCA) score, inflammatory factor indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-10 (IL-10), interleukin-1β (IL-1β), monocyte chemokine-1 (MCP-1), and inducible nitric oxide synthase (iNOS)], serum cortisol (CORT), beta-amyloid (β-AP), adiponectin (ADP), NSE, and S100β. No significant differences in the preoperative MoCA score, TNF-α, IL-6, CRP, IL-10, IL-1β, MCP-1, iNOS, CORT, β-AP, ADP, NSE, and S100β levels were observed between the two groups (p>0.05). The postoperative MoCA score in the study group was significantly higher than that in the control group (p<0.05). The postoperative levels of TNF-α, IL-6, CRP and IL-1β in the study group were significantly lower than those in the control group (p<0.05), and the postoperative levels of IL-10, MCP-1 and iNOS in the study group were significantly higher than those in the control group (p<0.05). Parecoxib can notably inhibit the levels of postoperative inflammatory cytokines, improve neurological dysfunction, and reduce the occurrence of postoperative cognitive dysfunction in patients. The contents of serum NSE and S100β have potential value in the diagnosis of postoperative cognitive dysfunction in elderly patients.

Effect of Propofol and Isoflurane on Postoperative Cognitive Dysfunction Following Elective Laminectomy Surgery in Adult Elderly Patients: A Randomized Controlled Trial Study

Background: Postoperative cognitive dysfunction (POCD) is a significant complication, especially prevalent among elderly individuals following major surgical procedures. Objectives: This study aims to compare the impact of isoflurane and propofol on the occurrence of POCD in patients undergoing elective laminectomy surgery under general anesthesia. Methods: This randomized, double-blind clinical trial took place at Shariati Hospital in Tehran. Patients scheduled for elective laminectomy between December 2020 and November 2021 were enrolled in the study and randomized into 2 groups. Patients in Group P received a Propofol infusion, while patients in Group I were administered isoflurane. Cognitive function assessments were conducted using the Mini-Mental State Examination (MMSE) at 3-time points: Twelve hours before surgery and 6 and 24 hours after surgery. Results: The MMSE scores demonstrated a significant increase in the Propofol group compared to the Isoflurane group at the 6-hour and 24-hour post-surgery time points. However, no significant difference was observed at baseline before surgery (P = 0.04, P = 0.005, and P = 0.2, respectively). Conclusions: These findings suggest that the use of propofol for general anesthesia may be a favorable choice for surgical procedures in elderly patients.

Associations between Alzheimer's disease biomarkers and postoperative delirium or cognitive dysfunction: A meta-analysis and trial sequential analysis of prospective clinical trials.

The relationship between Alzheimer's disease biomarkers and postoperative complications, such as postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), remains a subject of ongoing debate. This meta-analysis aimed to determine whether there is an association between perioperative Alzheimer's disease biomarkers and postoperative complications. We conducted a meta-analysis of observational clinical studies that explored the correlation between Alzheimer's disease biomarkers and POD or POCD in patients who have undergone surgery, following PRISMA guidelines. The protocol was previously published (INPLASY: INPLASY202350001). A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases until March 2023. Surgical patients aged at least 18 years, studies focusing on POD or POCD, research involving Alzheimer's disease biomarkers, including Aβ or tau in blood or cerebrospinal fluid (CSF), and availability of the full text. Our meta-analysis included 15 studies: six focusing on POD and nine on POCD. The findings revealed a negative correlation between preoperative CSF β-amyloid 42 (Aβ42) levels and the onset of POD [mean difference -86.1, 95% confidence interval (CI), -114.15 to -58.05, I2 : 47%]; this association was strongly supported by trial sequential analysis (TSA). A similar negative correlation was discerned between preoperative CSF Aβ42 levels and the incidence of POCD (-165.01, 95% CI, -261.48 to -68.53, I2 : 95%). The TSA also provided robust evidence for this finding; however, the evidence remains insufficient to confirm a relationship between other Alzheimer's disease biomarkers [β-amyloid 40 (Aβ40), total tau (T-tau), phosphorylated tau (P-tau), and Aβ42/T-tau ratio] and POD or POCD. The study results indicate a negative correlation between preoperative CSF Aβ42 levels and the occurrence of both POD and POCD. Future investigations are warranted to identify the predictive cutoff value of preoperative CSF Aβ42 for POD and POCD.

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.

Prediction of postoperative cognitive dysfunction in patients with coronary artery disease after on­pump coronary artery bypass grafting

Coronary artery disease is the most common cause of death world­wide. On­pump coronary artery bypass grafting and cardioplegia remains the gold standard for the treatment of multivessel coronary disease. However, this method of surgical treatment has a number of perioperative complications, the most common of which is post­operative cognitive dysfunction (POCD).Aim. To develop a mathematical model for predicting the binary outcome "presence/absence of POCD deterioration" using Mini­Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for timely prevention of cognitive impairment in the early postoperative period.Material and methods. The study included 180 patients with coronary artery disease with stable angina who underwent on­pump coronary artery bypass grafting. The patients’ age [Me (Q25­-Q75)] was 62 [56­-67] years. After the operation, all patients were divided into 2 groups: 108 patients without POCD and 72 patients with cognitive deficit of various severity. The study was conducted in three stages: stage I — 2 days before surgery; stage II — during the operation; stage III — 7 days after the operation. Assessment of cognitive status using FAB, MMSE tests was carried out at stages I and III. At the second stage, biochemical parameters were assessed: in arterial blood — lactate and hemoglobin levels, in venous blood — pH, partial pressure of carbon dioxide (pCO2, mm Hg) and partial pressure of oxygen (pO2, mm Hg), as well as the duration of operation, cardiopulmonary bypass and myocardial anoxia. Discriminant analysis was used to develop a mathematical model for predicting a binary outcome.Results. Two groups of the most informative indicators were identified that were included in prediction algorithms for binary outcomes "presence/absence of negative dynamics of POCD" for MMSE and FAB. Group 1 included perioperative MMSE values, atrial fibrillation before surgery, cardiopulmonary bypass time and pO2. Group 2 included cardiopulmonary bypass time and intraoperative venous pH. Conclusion. Mathematical models have been developed for predicting the binary outcome "presence/absence of POCD deterioration" ac­cording to the MMSE and FAB cognitive tests, which make it possible to assess the possibility of postoperative cognitive dysfunction. The proposed algorithms are implemented using spreadsheets and a computer program.

Post-operative cognitive dysfunction in patients following gastrointestinal endoscopic treatment

We aimed to explore the changes in post-operative cognitive dysfunction (POCD) after gastrointestinal endoscopic treatment using detailed neuropsychological assessments. Patients hospitalized for gastrointestinal endoscopic polypectomy were recruited for neuropsychological evaluations, which included the Chinese version of the Mini-Mental State Examination (MMSE), Auditory-Verbal Learning Test, Digit Span Test (DST), Trail Making Task (TMT), Verbal Fluency Test, Clock Drawing Test, and Stroop test. Cognitive assessments were performed twice: one day before and 24 h after treatment. Healthy control subjects participated in the neuropsychological assessment during the same intervals. Detailed cognitive assessments were performed for 40 patients and 60 control subjects. Based on the Z scores, the incidence of POCD 24 h after gastrointestinal endoscopic treatment was 20%. Patients with POCD had significant impairment in the post-operative MMSE, forward DST, TMT, and Stroop interference effect correct count tests (all p < 0.05). Our preliminary results showed that patients were not fully recovered, and 20% had impairment in multiple cognitive assessments 24 h after a gastrointestinal endoscopy. As attention was affected, safety while discharging those patients should be a concern.

Efficacy of intraoperative subanesthetic dose of ketamine/esketamine in preventing postoperative cognitive dysfunction: a systematic review and meta-analysis.

Postoperative cognitive dysfunction (POCD) is a common complication after anesthesia surgery, especially in older people, that can persist weeks or months after surgery as a short-term impairment of cognitive abilities, or even for a prolonged duration over years, potentially progressing into permanent cognitive dysfunction. However, the pathogenesis of POCD is not fully understood, and therefore an optimal solution for preventing POCD has yet to be established. Some studies have shown that intraoperative ketamine/esketamine reduces the incidence of POCD, but this remains controversial. We evaluated the effect of intraoperative subanesthetic doses of ketamine/esketamine versus no intervention in adults undergoing general anesthesia surgery on the incidence of POCD. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the PubMed, Embase, Ovid, Cochrane, Scopus, and Web of Science databases for the MeSH terms 'ketamine', 'esketamine', and 'Postoperative Cognitive Complications' from database inception to 25 June 2023. We found no statistically significant difference in the incidence of POCD within 7 days for intraoperative subanesthetic dose of ketamine/esketamine compared with the control group [relative risk (RR) = 0.57, 95% confidence interval (CI): 0.32, 1.01], and the results from the subgroup analysis based on age (>60 years) also revealed that the difference was not statistically significant (RR = 0.49, 95% CI: 0.23, 1.04). Compared with controls, intraoperative subanesthetic dose of ketamine/esketamine has no advantage in preventing POCD in patients, or in elderly patients. This study provides reference data for POCD research and clinical drug intervention strategies. Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023401159).

Postoperative Assessment of Cognitive Dysfunction in Patients Undergoing Transurethral resection of the Prostate under Spinal Anaesthesia: A Prospective Cohort Study

Introduction: Postoperative Cognitive Dysfunction (POCD) is a common disorder following surgery that threatens the quality of patients’ lives. POCD is closely associated with perioperative factors such as age, physical state, surgery duration, anaesthesia method, intraoperative hypotension, and infection. Among these factors, age is the only long-term risk factor for POCD. The relationship between anaesthesia depth and the incidence of POCD is debatable. Aim: To assess POCD in patients undergoing Transurethral Resection of the Prostate (TURP) and to examine the association between the duration of surgery and serum sodium levels with cognitive dysfunction. Materials and Methods: A prospective observational study was conducted at the Department of Anesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The study included 100 patients aged over 60 years who were scheduled for TURP surgery under Spinal Anaesthesia. The Mini-Mental State Examination (MMSE) test was performed in the preoperative holding area, and the results were recorded. A decline in cognitive function was defined as a loss of 2 or more points on the MMSE test compared to the preoperative value. Serum sodium levels and MMSE scores were measured before surgery. Serum sodium levels and MMSE scores were also recorded after the 1st hour and 6th hour postoperatively. The data were entered into MS Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: In the present study, out of 100 subjects, the majority of patients (33%) belonged to the age group of 66-70 years, and most of the study subjects (79%) were classified as American Society of Anesthesiologists (ASA) II status, followed by ASA III status. The mean age of the study participants was 69.3 years. The mean duration of surgery was 45.6 minutes. A statistically significant difference (p&lt;0.05) was observed when comparing the mean serum sodium levels before surgery (138.1±1.5 mmol/L) with those at the 1st hour postoperatively (135.9±1.6 mmol/L) and 6th hour postoperatively (134.4±1.4 mmol/L). The mean MMSE score before surgery and at the 1st hour and 6th hour postoperatively was the same (27.6±0.8), and there was no statistically significant difference between them. The MMSE score did not vary with the serum sodium levels, and this difference was not statistically significant (p&gt;0.05). Conclusion: In the present study, patients undergoing TURP procedures under spinal anaesthesia did not exhibit any POCD, despite a considerable drop in serum sodium levels. It is worth noting that all patients were asymptomatic.

Effects of LncRNA GAS5/miR-137 general anesthesia on cognitive function by TCF4 inflammatory bodies in patients undergoing lumbar spinal canal decompression.

Lumbar spinal stenosis is a common orthopedic disease in clinical practice at present. Postoperative cognitive dysfunction (POCD) refers to the phenomenon of impaired memory. However, whether long noncoding RNA (LncRNA) GAS5 contributes to the mechanism of cognitive function in undergoing lumbar spinal canal decompression remains unknown. Thus, the present study investigated the precise details of LncRNA GAS5 involvement in Postoperative cognitive dysfunction of patients undergoing lumbar spinal canal decompression. Patients undergoing lumbar spinal canal decompression with cognitive function and Normal healthy volunteers were obtained. C57BL/6 mice were maintained with a 2% concentration of sevoflurane in 100% oxygen at a flow rate of 2 L minute-1 for 4 hours. LncRNA GAS5 gene expression were up-regulated in patients undergoing lumbar spinal canal decompression. In mice model, LncRNA GAS5 gene expression also increased. LncRNA GAS5 promoted neuroinflammation in vitro model. LncRNA GAS5 raised cognitive impairment and increased neuroinflammation in mice model. LncRNA GAS5 suppressed miR-137 in vitro model. MiR-137 reduced neuroinflammation in vitro model. MiR-137 suppressed TCF4 protein expression in vitro model. Transcription factor TCF4 activates the expression of bHLH. Taking together, this experiment provide the first experimental and clinical evidence that LncRNA GAS5/miR-137 promoted anesthesia-induced cognitive function to increase inflammatory bodies in patients undergoing lumbar spinal canal decompression, suggesting it may be a biomarker of POCD and a potential therapeutic target for POCD.

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.

The Relationship between the Incidence of Postoperative Cognitive Dysfunction and Intraoperative Regional Cerebral Oxygen Saturation after Cardiovascular Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: To assess whether intraoperative monitoring and intervention of regional cerebral oxygen saturation levels can reduce the incidence of postoperative cognitive dysfunction in patients undergoing cardiovascular surgery and contribute to patient prognosis. Methods: The Cochrane Library, PubMed, and the Web of Science were systematically searched for relevant randomized controlled trials involving the effects of cerebral oxygen saturation on the cognitive function of patients after cardiovascular surgery from January 1, 2000 to May 1, 2022. The primary outcome was the incidence of postoperative cognitive dysfunction. The secondary outcomes were length of hospital stay, length of intensive care unit (ICU) stay, length of mechanical ventilation, length of cardiopulmonary bypass, and other major postoperative outcomes such as renal failure, infection, arrhythmia, hospital mortality, and stroke. Data were pooled using the risk ratio or standardized mean difference with 95% confidence interval (CI). The original study protocol was registered prospectively with PROSPERO (CRD42020178068). Results: A total of 13 randomized controlled trials involving 1669 cardiovascular surgery patients were included. Compared with the control group, the risk of postoperative cognitive dysfunction was significantly lower in the intervention group (RR = 0.50; 95% CI: 0.30 to 0.85; p = 0.01; I2 = 71%). The Duration of stay in intensive care units in the intervention group was also significantly shorter than that in the control group (standard mean difference (SMD) = –0.14; 95% CI: –0.26 to –0.01; p = 0.03; I2 = 26%). Univariate meta-regression analyses showed that age is a major source of heterogeneity. Conclusions: Our current study suggests that intraoperative cerebral oxygen saturation monitoring and intervention can significantly reduce the incidence of postoperative cognitive dysfunction, and the length of intensive care unit stay after intervention is considerably reduced. Given that some limits in this review, more high-quality, and long-term trials are still needed to certify our findings.

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.

Elevated serum alkaline phosphatase correlates with postoperative cognitive dysfunction: A retrospective cohort study based on STROBE statement.

Little is known about the association between serum alkaline phosphatase (ALP) levels and postoperative cognitive dysfunction (POCD) after general anesthesia. Thus, we investigated the association of serum ALP levels with POCD in patients who underwent surgery with general anesthesia in a retrospective cohort study. We retrospectively collected data from patients who underwent surgery with general anesthesia between May 2016 and June 2020. Serum ALP activity was detected using a p-nitrophenyl phosphate assay. Pre-and postoperative cognitive function were evaluated using the Chinese version of the Mini-Mental State Examination. Univariate and multivariate logistic regression were used to explore the effect of ALP on cognitive function. The incidence of POCD was 13.5%. Compared with the control group, the POCD group had higher ALP levels. The neuropsychological test results suggested that the scores of most items were lower in the POCD group than in the non-POCD group. Univariate logistic regression indicated that increased ALP levels were significantly associated with cognitive dysfunction (odds ratio = 1.15, 95% confidence interval: 1.13-1.18, P = .000). Multivariate regression showed that elevated ALP was still associated with POCD after adjusting for confounding factors (odds ratio = 1.16, 95% confidence interval: 1.13-1.18, P = .000). The spline regression model indicated the dose-response associations between ALP level and POCD risk (P for nonlinear trend < .001). Our study indicated that elevated serum ALP was an independent predictive factor of POCD at the 3-month follow-up. The occurrence of POCD could be associated with inflammatory status.

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.

Effectiveness of dual-task computerized cognitive training in the prevention of postoperative cognitive dysfunction in coronary bypass surgery

Aim. To evaluate the effectiveness of dual-task computerized cognitive training (CCT) in the prevention of postoperative cognitive dysfunction in patients after on-pump coronary artery bypass grafting (CABG).Material and methods. This cohort prospective study included 68 patients (median age, 64 years [54; 69]) admitted for elective on-pump CABG. In addition to the standard preoperative examination, all patients underwent advanced neuropsychological and neurophysiological examination. Starting from 3-4 days of the postoperative period, all patients underwent dual-task CCT.Results. After 8-10 days, early postoperative cognitive dysfunction was observed in 37 (54,4%) patients from CCT group, while in patients without training in 69,3% of cases (n=79). The best results of cognitive functioning were achieved in neurodynamics and short-term memory. In addition, in patients who completed the training course, a postoperative increase in the frontooccipital gradient of theta rhythm was observed.Conclusion. Neuropsychological and neurophysiological assessment have demonstrated the limited effectiveness of a short-term dual task CCT using in the prevention of early postoperative cognitive dysfunction in patients after on-pump CABG. The dual task method can be an additional preventive intervention in the development of a personalized approach to cognitive rehabilitation therapy in cardiac surgery patients.

Post-Coronary Artery Bypass Grafting Cognitive Decline: Risk Modification And Implications For Screening In Low-Risk Population

Background — Postoperative cognitive dysfunction (POCD) is an important complication of coronary artery bypass grafting (CABG). Large amount of data points to the problem of POCD in patients with high surgical risk of CABG. Low-risk patients are not safe from these complications either. Assessment of the severity, duration of POCD, degree of recovery and risk factors in off- and on-pump patients with stable coronary artery disease is crucial in minimization of the POCD risk in patients with low surgical risk. Objective — to analyze incidence, severity, reversibility and risk factors of POCD in patients undergoing elective low-risk CABG. Methods and Results — The retrospective cohort study included 79 patients who underwent on-pump (N=44) or off-pump (N=35) elective CABG with low surgical risk (mean EuroSCORE II death risk 1.08±0.71%), with observation period of 6 months. Pre-CABG markers of cognitive impairment were found in 50% of patients, with 44% of patients demonstrating POCD. Patients who underwent off-pump CABG demonstrated more pronounced decline in MoCA score compared to on-pump (-3.9±2.0 vs. -2.2±2.0 at 8 days point, p=0.018), with regress to pre-CABG results after 3 weeks. Baseline MoCA score &lt;25 was found to be a predictor for more pronounced cognitive decline at 8 days point. MMSE demonstrated less predictive value compared to MoCA. Conclusion — POCD risk differs in off-pump and on-pump CABG cohorts, with significantly higher prevalence in the former group, whether assessed using MMSE or MoCA tests. Differences are observed within 3 weeks post-CABG. Pre-CABG MoCA score &lt;25 is associated with more pronounced POCD in low-risk elective CABG cohort.