Postoperative Cognitive Recovery Research Articles

Irreversible postoperative cognitive impairment after unruptured intracranial aneurysm treatment in the elderly.

Postoperative cognitive dysfunction and recovery remain unclear in older patients undergoing interventional therapies for unruptured intracranial aneurysms (UIAs). This study aimed to compare changes in postoperative cognitive function between younger and older patients and to detect factors associated with non-recovery from postoperative cognitive dysfunction. This study reviewed 59 consecutive patients with UIAs who underwent interventional therapies, including microsurgical clipping or endovascular treatment, from 2021 to 2022. All patients were divided into the older (aged ≥ 70years) and younger (aged < 70years) groups. Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were performed within 2months before interventions, at 1week postoperatively (POW1), and 3-6months postoperatively (POM3-6). MMSE and FAB scores decreased more frequently in the older group than in the younger group at POW1 (older vs. younger: MMSE: 48% vs. 21%, p < 0.05; FAB: 56% vs. 18%, p < 0.01). In the older group, the FAB Z-score decreased in POW1 and recovered by POM3-6 (p < 0.01), while the MMSE Z-score continued to decrease (p = 0.04). Age and the preoperative MSME Z-score were significantly associated with non-recovery from decreased MMSE score at POM3-6 (recovery vs. non-recovery, age: 62years old vs. 72years old, p = 0.03, preoperative MMSE Z-score: 0.16 vs. - 0.90, p < 0.01). This retrospective study found that older patients were more likely to have a postoperative cognitive decline after UIA treatment and implicated that global cognitive function tended to decline more than executive function in the long term. In addition, this study demonstrated that lower preoperative cognitive function was associated with inadequate postoperative cognitive recovery. The findings potentially contribute to the establishment of indications for treating UIAs in older patients.

Effect of memory therapy on enhancing postoperative cognitive function recovery and alleviating mood disturbances in brain glioma patients.

To assess the impact of memory therapy on enhancing recovery of postoperative cognitive function and alleviating mood disturbances in brain glioma patients. This retrospective study included 160 brain glioma patients who met the inclusion criteria from August 2019 to July 2022. They were divided into a control group and an observation group according to according to different treatment method, with 80 cases in each group. The control group was given routine rehabilitation, while the observation group received additional memory therapy. The study compared complications between the two groups, focusing on the changes in cognitive function [using the Neurobehavioral Cognitive Status Check Scale (NCSE), Clinical Dementia Score (CDR)], mood disturbances [measured by the State Anxiety Scale (S-AI), Trait Anxiety Scale (T-AI), and Hospital Stress Scale score], health-promoting behaviors [evaluated with the Chinese Version of Health Promotion Lifestyle Scale-II (HPLP-II)], coping styles [assessed through the Medical Response Questionnaire (MCQM)], and cancer-related fatigue [using the Cancer-Related Fatigue Scale (CFS)] before and after intervention were observed. A total of 160 glioma cases were classified into either a good or poor prognosis category, based on their prognosis 12 months post-surgery. Baseline data from both groups were compared, and multivariate logistic regression was employed to analyze the factors influencing outcomes in glioma patients. After intervention, the observation group exhibited higher scores of NCSE, HPLP-II, and CFS, but lower scores on the CDR, S-AI, T-AI and hospital stress scale compared to the control group (all P<0.05). Additionally, within the MCQM, the observation group showed reduced avoidance and yield scores, and an increased facing score, compared to the control group (all P<0.05). No significant difference was observed between the complication rates of the control (8.75%) and observation groups (3.75%) (P>0.05). However, the incidence of adverse prognosis was significantly lower in the observation group compared to the control group (8.75% vs 22.50%) (P<0.05). There were no significant differences in age, maximum tumor diameter, preoperative Karnofsky Performance Status score, gender or lesion location between the poor prognosis group and the good prognosis group (all P>0.05). The poor prognosis group had a higher proportion of patients in clinical stages III-IV and a lower proportion receiving recall therapy compared to good prognosis group (P<0.05). Multivariate logistic regression analysis identified clinical stage (III-IV stage) [OR=3.562 (95% CI: 1.476-8.600)] as a risk factor for poor prognosis after brain glioma surgery (P<0.05), while undergoing memory therapy [β=0.330 (95% CI: 0.99-0.842)] acted as a protective factor against poor prognosis (P<0.05). Memory therapy has been shown to promote postoperative cognitive function recovery in glioma patients, reduce anxiety and stress response, bolster coping mechanisms and health-promoting behavior, diminish cancer-related fatigue, and improve patient prognosis.

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in older people: a randomized controlled clinical trial

BackgroundPeripheral nerve block, including the quadratus lumborum block (QLB), has been used for postoperative analgesia in hip surgery. However, the effects of QLB on cognitive function after hip surgery remain unknown. This study aimed to assess the effects of the anterior approach to QLB on postoperative cognitive function in older people undergoing hip surgery.MethodsSixty older people who underwent hip surgery from May 2021 to May 2022 were randomly divided into the QLB (n = 30) and control groups (n = 30). The Montreal Cognitive Assessment (MoCA) score (mean ± SD) was measured one day preoperatively and seven and 30 days postoperatively. The frequency (%) of postoperative cognitive dysfunction (POCD) was examined seven and 30 days postoperatively. The visual analog scale (VAS) scores at rest and Bruggrmann comfort scale (BCS) scores [Median (IQR)] 6 h (t1), 12 h (t2), 24 h (t3), and 48 h (t4) after surgery were assessed. The plasma high mobility group box protein 1 (HMGB1) and levels of interleukin-6 (IL-6) (mean ± SD) were evaluated 1 h preoperatively (baseline) and 24 h postoperatively (day 1). The requirement for rescue analgesia [Median (IQR)], time to first off-bed activity (mean ± SD), and adverse effects after surgery were also recorded.ResultsCompared with the control group, the frequency of POCD was significantly lower in the QLB group seven days postoperatively (10.7% vs. 34.5%, P = 0.033), but no difference at 30 days postoperatively (3.6% vs. 10.3%, P = 0.319). There was no significant difference in MoCA scores between the two groups at one day preoperatively and 30 days postoperatively. However, the MoCA scores at seven days postoperatively were higher in the QLB group than in the control group (27.4 ± 1.81 vs. 26.4 ± 1.83, P = 0.043). In the QLB group, the VAS scores at t1, t2, and t3 were lower [3(2–4) vs. 4(3–4), P = 0.028; 3(2–3) vs. 4(3–5), P = 0.009; 2(1–3) vs. 2(2–3), P = 0.025], and the BCS scores at t1, t2, and t3 were higher than those in the control group [3(1–3) vs. 1(1–2), P = 0.006; 3(2–3) vs. 2(1–3), P = 0.011; 3(2–4) vs. 2(2–3), P = 0.041]. The patients in the QLB group reported significantly fewer requirements for rescue analgesia [0(0–1) vs. 1(0–2), P = 0.014]. The plasma levels of HMGB1 and IL-6 at 24 h postoperatively in the QLB group were significantly lower than in the control group (749.0 ± 185.7 vs. 842.1 ± 157.9, P = 0.046; 24.8 ± 8.1 vs. 31.9 ± 5.5, P < 0.001). The time to first off-bed activity from the end of surgery was shorter in the QLB group (25.3 ± 5.3 vs. 29.7 ± 6.9, P = 0.009). There was no significant difference in the incidence of postoperative complications between the two groups.ConclusionsAnterior QLB given to older people undergoing hip surgery could promote early postoperative cognitive function recovery, provide adequate postoperative analgesia, and inhibit the release of inflammatory factors.Trial registrationChictr.org.cn identifier ChiCTR2000040724 (Date of registry: 08/12/2020, prospectively registered).

Postoperative cognitive recovery and prevention of postoperative cognitive complications in the elderly patient.

Elderly patients undergoing surgery are at higher risk of life-altering and costly complications. This challenge is increasingly recognized with the growing geriatric surgical population. Advanced age and comorbid conditions, such as disability and frailty that often develop with age, are all independent risk factors of postoperative morbidity and mortality. A common factor in this age group is cognitive impairment, which poses a challenge for the patient and clinician in the perioperative setting. It affects the capacity for informed consent and limits optimization before surgery; furthermore, an existing impairment may progress in severity during the perioperative period, and new onset of signs of delirium or postoperative cognitive dysfunction may arise during postoperative recovery. In this article, we aim to review the current literature examining the latest definitions, diagnostic criteria, and preventive strategies that may ameliorate postoperative cognitive complications.

Comparison of Sevoflurane and Halothane Anesthesia Cognitive Function in Adult

Background: Patients reach their full cognitive and psychomotor potential during the intermediate period of recovery. We still utilize Halothane, which has a delayed recovery profile, despite the fact that rapid clearance drugs like Sevoflurane have a positive impact on early cognitive recovery, which permits early mobility and reduces post-surgical complications. Objective: The study's goal was to promote the use of sevoflurane over halothane by contrasting the two anesthetics' effects on patients' cognitive functioning after surgery. Method: The prospective randomized comparative study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, between the period of September 2021 to June 2022. Study population was the patients of either sex, aged between18-50 years, ASA-I and II, patients undergoing elective surgery by general anaesthesia, lasting for 1 hour or more and remaining 24 hours after surgery. A total number of 100 patients were divided into two groups. 50 patients were in Sevoflurane group and 50 in Halothane group. Results: Group- Sevoflurane had a considerably faster emergence time (10.85 min vs. 15.13 min, P0.001) than Group- Halothane. Group- Sevoflurane had a mean BAMSE score of 29 at baseline and showed no change by the conclusion of the observation period, but Group- Halothane saw their scores both drop and then recover. Patients in Group- Sevoflurane finished the (TMT-A) 30 minutes after regaining consciousness in a considerably shorter amount of time (40. 9 seconds vs. 55. 8 seconds, P 0.001). Furthermore, there was no statistically significant difference between the groups after 1.5 hours, 2.5 hours, or 3.5 hours. Conclusion: So the study concludes that adult patient of sevoflurane group experienced an early post-operative cognitive recovery than halothane group. Though sevoflurane is costly, considering the benefits of patients in terms of early cognitive recovery that causes less postoperative complications and shorter hospital stay, sevoflurane should be used instead of halothane.

Risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery

BackgroundTo investigate the risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery.MethodsA total of 215 elderly patients who underwent thoracic surgery between May 2022 and October 2022 were recruited in this prospective observational study. Cognitive function was tested by MoCA tests that were performed by the same trained physician before surgery, on postoperative day 4 (POD4), and on postoperative day 30 (POD30). Univariate and multivariate logistic regression models were used to analyze the risk factors for DNR.ResultsA total of 154 patients (55.8% men) with an average age of 67.99 ± 3.88 years were finally included. Patients had an average preoperative MoCA score of 24.68 ± 2.75. On the 30th day after surgery, 26 (16.88%) patients had delayed postoperative cognitive recovery, and 128 (83.12%) had postoperative cognitive function recovery. Diabetes mellitus (OR = 6.508 [2.049–20.664], P = 0.001), perioperative inadvertent hypothermia (< 35℃) (OR = 5.688 [1.693–19.109], P = 0.005), history of cerebrovascular events (OR = 10.211 [2.842–36.688], P < 0.001), and VICA (sevoflurane combined with propofol anesthesia) (OR = 5.306 [1.272–22.138], P = 0.022) resulted as independent risk factors of delayed neurocognitive recovery. On the POD4, DNR was found in 61 cases (39.6%), and age ≥ 70 years (OR = 2.311 [1.096–4.876], P = 0.028) and preoperative NLR ≥ 2.5 (OR = 0.428 [0.188–0.975], P = 0.043) were identified as independent risk factors.ConclusionsThe risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery include diabetes, perioperative inadvertent hypothermia (< 35℃), VICA (sevoflurane combined with propofol anesthesia), and history of cerebrovascular events.

Retracted: Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery.

[This retracts the article DOI: 10.1155/2022/9147416.].

Perioperative Dexmedetomidine Infusion might improve Postoperative Cognitive Function Recovery in Traumatic Brain Injury Patients

Perioperative Dexmedetomidine Infusion might improve Postoperative Cognitive Function Recovery in Traumatic Brain Injury Patients

The Effects of Dexmedetomidine on Postoperative Sleep in Elderly Patients: A Systematic Review and Meta-Analysis

Background: Postoperative sleep disorders in elderly patients may increase the risk of postoperative delirium or cognitive dysfunction and delay recovery. Therefore, it is imperative to develop innovative approaches to prevent and treat postoperative sleep disorders.Objective: This study aims to systematically evaluate the effects of perioperative use of dexmedetomidine on postoperative sleep in elderly patients.Methods: We searched for randomized controlled trials (RCTs) in Embase, PubMed, The Cochrane library, Web of Science, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Google Scholar databases from the establishment of the database to November 2020. Two researchers independently screened the literature, extracted information, and assessed bias risk. They cross-checked their findings .Any discrepancies were resolved through discussion or consultation with a third party. The risk of bias in the included studies was evaluated using RevMan 5.3, and meta-analysis, sensitivity analysis, and publication bias analysis were conducted using Stata 13.0.Results: A total of 23 studies involving 2,969 patients were included in the meta-analysis. The results of the meta-analysis showed that the subjective sleep quality score of the dexmedetomidine group was lower than that of the control group on the first day after surgery, with statistical significance [SMD = −1.29, 95%CI (−1.60, −0.98), P < 0.001, I2 = 89.7%]. The incidence of postoperative sleep disorders in the dexmedetomidine group was lower than that in the control group [RR = 0.49, 95% CI (0.30, 0.79), P = 0.003, I2 = 36.2%]. The duration of ICU stay and hospitalization in the dexmedetomidine group was also shorter than that in the control group [ICU stay: SMD = −0.98, 95% CI (−1.76, −0.19), P = 0.015, I2 = 88.8%; Hospitalization: SMD = −0.56, 95% CI (−0.95, -0.16), P = 0.006, I2 = 92.7%]. In terms of adverse events, the number of patients with postoperative bradycardia in the dexmedetomidine group was higher than that in the control group [RR = 1.629, 95% CI (1.291, 2.054), P < 0. 001, I2 = 0.0%]. The number of patients with postoperative hypotension was also higher in the dexmedetomidine group than in the control group [RR = 1.328, 95% CI (1.087, 1.622), P = 0. 003, I2 =2.1%]. On the other hand, the incidence of postoperative agitation was lower in the dexmedetomidine group than that in the control group [RR =0.193, 95% CI (0.075, 0.500), P = 0. 001, I2 = 0.0%], as was the incidence of postoperative tachycardia [RR = 0.486, 95% CI (0.348, 0.678), P < 0. 001, I2 = 0.0%].Conclusion: The perioperative use of dexmedetomidine in elderly patients can effectively improve subjective postoperative sleep quality, reduce the incidence of postoperative sleep disorders, shorten ICU and hospital stay, and has favorable safety.

Novel benzodiazepine remimazolam tosylate delays neurodegeneration of aged mice via decreasing tau phosphorylation

Benzodiazepines like midazolam were generally considered one of the possible causes affecting postoperative cognitive recovery. As a new kind of rapid-effect benzodiazepine, remimazolam tosylate was widely used in clinical anesthesia for its pharmacological advantage, but few studies reported its effects on cognitive function in the elderly. Here, we aimed to research the effects of remimazolam tosylate on cognitive function in aged mice and its underlying biological mechanisms. We measured the memory function of aged mice immediately and one month after intraperitoneal injection of remimazolam tosylate compared to the saline control. The brain metabolism level was detected by Positron Emission Tomography/Computed tomography (PET/CT). Compared with the control, we observed a decrease in memory ability， as well as an increase in tau phosphorylation level and a decrease in phosphatase level in the short term; however, one month later, contrary to the previous results, we observed better memory and brain metabolism and lower tau phosphorylation levels in the experimental group compared to the control. Therefore, we concluded that remimazolam tosylate did not cause long-term damage to the cognitive function of aged mice and even delayed the decline of memory function in the aging process to some extent.

Structural Brain Network Reorganization Following Anterior Callosotomy for Colloid Cysts: Connectometry and Graph Analysis Results.

Introduction:The plasticity of the neural circuits after injuries has been extensively investigated over the last decades. Transcallosal microsurgery for lesions affecting the third ventricle offers an interesting opportunity to investigate the whole-brain white matter reorganization occurring after a selective resection of the genu of the corpus callosum (CC).MethodDiffusion MRI (dMRI) data and neuropsychological testing were collected pre- and postoperatively in six patients with colloid cysts, surgically treated with a transcallosal-transgenual approach. Longitudinal connectometry analysis on dMRI data and graph analysis on structural connectivity matrix were implemented to analyze how white matter pathways and structural network topology reorganize after surgery.ResultsAlthough a significant worsening in cognitive functions (e.g., executive and memory functioning) at early postoperative, a recovery to the preoperative status was observed at 6 months. Connectometry analysis, beyond the decrease of quantitative anisotropy (QA) near the resection cavity, showed an increase of QA in the body and forceps major CC subregions, as well as in the left intra-hemispheric corticocortical associative fibers. Accordingly, a reorganization of structural network topology was observed between centrality increasing in the left hemisphere nodes together with a rise in connectivity strength among mid and posterior CC subregions and cortical nodes.ConclusionA structural reorganization of intra- and inter-hemispheric connective fibers and structural network topology were observed following the resection of the genu of the CC. Beyond the postoperative transient cognitive impairment, it could be argued anterior CC resection does not preclude neural plasticity and may subserve the long-term postoperative cognitive recovery.

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery.

Objective To investigate the anesthesia effect of remifentanil combined with propofol for laparoscopic cholecystectomy and its impact on postoperative cognitive recovery. Methods A total of 120 patients who underwent laparoscopic cholecystectomy in our hospital from February 2019 to June 2021 were recruited and assigned into either control group or experimental group at a ratio of 1 : 1 via the random number table method. The patients in the control group were anesthetized with fentanyl combined with propofol, and the patients in the experimental group were anesthetized with remifentanil combined with propofol. The clinical basic indicators (extubation time, recovery time, breathing recovery time, and orientation recovery time), and observer's assessment of awareness/sedation (OAA/S) scores and complications were compared between the two groups. Results There was no significant difference in extubation time between the two groups (P > 0.05). The postoperative wake-up time, respiratory recovery time, and orientation recovery time of the experimental group were significantly better than those of the control group (P < 0.05). The OAA/S scores of the patients in the experimental group were significantly higher than those in the control group immediately after surgery, 1 h after surgery, and 3 h after surgery (P < 0.05). There was no significant difference in the OAA/S scores between the two groups on the 1st day after operation (P > 0.05). The incidence of complications in the experimental group was significantly lower than that in the control group (P < 0.05). Conclusion Remifentanil + propofol for laparoscopic cholecystectomy patients has a significant anesthesia effect. This strategy effectively shortens the extubation, awakening, respiratory recovery, orientation recovery time of patients, and OAA/S score, suggest a minor impact on the postoperative cognitive function and state of consciousness. It has a high safety profile and thus is worthy of clinical application.

Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery.

To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. The study sample consisted of 80patients aged 18-65years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was asignificant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.

Comparative Study of Recovery and Cognitive Dysfunction Following Desflurane versus Sevoflurane in General Anesthesia in Elderly Patient Undergoing Major Surgery

Geriatric patients (age 65 years and above) are more prone to POCD who undergo general anesthesia. Also the geriatric patients with co morbidities and substance abuse have higher chances for POCD. Objective: To compare Post-operative cognitive status and recovery (time specific) in geriatric patients undergoing general anesthesia with sevoflurane or desflurane, by MMSE score. Also to compare other side effects and recovery. Materials and Methods: This is prospective, randomized, interventional, single blind study. A study of 70 patients of either sex, ASA-I/II/III in the age group of above 65 years who were operated under general anesthesia and randomly allocated in two equal groups. Group S consisted of 35 patients who were given sevoflurane. Group D consisted of 35 patients who were given desflurane. MMSE score was taken pre-operatively and patients with score more than 27 were selected for this study. Results: Statistically significant immediate recovery from general anesthesia was noted in group D compared to group S. But difference in post-operative MMSE score at 1 hour, 3 hours and 6 hours between group S and group D was statistically insignificant. Conclusion: Patients given General Anesthesia with Desflurane showed early recovery signs, i.e. eye opening, following of verbal commands and extubation compared to patients given sevoflurane which is statistically proven. But MMSE score was lesser in desflurane than sevoflurane, which was insignificant.

Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial

To investigate the effects of a 12-week early moderate-intensity resistance training program compared to aerobic-based rehabilitation on postoperative cognitive recovery following cardiac surgery via median sternotomy. This was a multicentre, prospective, pragmatic, non-blinded, pilot randomised controlled trial (1:1 randomisation) of two parallel groups that compared a 12-week early moderate-intensity resistance training group to a control group, receiving aerobic-based rehabilitation. English-speaking adults (≥18 years) undergoing elective cardiac surgery via median sternotomy were randomised using sealed envelopes, with allocation revealed before surgery. The primary outcome was cognitive function, assessed using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14 weeks and 6 months postoperatively. The ADAS-cog score at 14 weeks was significantly better for the resistance training group (n=14, 7.2±1.4; 95% CI 4.3, 10.2, vs n=17, 9.2±1.3; 95% CI 6.6, 11.9, p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based rehabilitation group (n=9/17) experienced cognitive decline by two points or more from baseline ADAS-cog score, compared to 0% of the resistance training group (n=0/14; p=0.001). Early resistance training appears to be safe and may improve cognitive recovery compared to standard, aerobic-based rehabilitation following cardiac surgery via median sternotomy, however as this was a pilot study, the sample size was small and further research is needed to determine a causal relationship.

The impact of inhalation anesthetics on early postoperative cognitive function and recovery characteristics in Down syndrome patients: a randomized, double \u2013 blind study

BackgroundDown syndrome (DS) is associated with intellectual disability. DS patients may be unable to cooperate and often require general anesthesia even for minor surgeries. Rapid recovery significantly contributes to fast-tracking. This prospective randomized, double - blind study investigates the impact of desflurane and sevoflurane on recovery and early postoperative cognitive function of these patients.MethodsForty-four patients undergoing dental surgery, were randomized to receive desflurane (DES-group) or sevoflurane (SEVO-group) for anesthesia maintenance. The primary outcome was postoperative cognitive function (Prudhoe Cognitive Function Test, PCFT) at 90 min and 4 h postoperatively. Secondary outcome measures were the time between volatile discontinuation and spontaneous breath, eye opening, extubation, orientation and response to commands, time to achieve an Aldrete score ≥ 9 in the Post-anesthesia Care Unit and time to fulfill discharge criteria (Post Anesthetic Discharge Scoring System, PADSS).ResultsAt 90 min, PCFT scores significantly decreased from baseline in both groups. Nevertheless, at 4 h, in DES-group there was no significant change from baseline (p = 0.163), while in SEVO-group the decrease remained significant (p < 0.001). Desflurane was also found superior regarding recovery characteristics, such as time to eye opening (p = 0.021), spatial orientation (p = 0.004), response to commands (p = 0.004). Discharge criteria were met earlier in DES-group (p = 0.018 for Aldrete score / p < 0.001 for PADSS).ConclusionsDesflurane was found superior to sevoflurane in terms of faster recovery and better preserved postoperative cognitive function in DS patients undergoing dental surgery. We suggest that desflurane, as part of a multimodal anesthetic approach, could be a useful agent to enhance early discharge from hospital of ambulatory patients with intellectual disability.Trial registrationRegistered with ClinicalTrials.gov (NCT02971254, principal investigator: E.G; November 2016).

The international ENIGMA-II substudy on postoperative cognitive disorders (ISEP)

There is a large controversy as to whether nitrous oxide (N2O) added to the anaesthetic gas mixture is harmful or harmless for postoperative cognitive function recovery. We performed a nested study in the ENIGMA-II trial and compared postoperative neurocognitive recovery of patients randomly receiving N2O (70%) or Air (70%) in 30% O2 during anesthesia. We included adults having non cardiac surgery. We compared recovery scores for episodic memory, decision making/processing speed and executive functions measured with the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB). Assessments were performed at baseline, seven and ninety days. At first interim analysis, following recruitment of 140 participants, the trial was suspended. We found that the mean (95%CI) changes of scores for episodic memory were in the Pocock futility boundaries. Decision making/processing speed did not differ either between groups (P > 0.182). But for executive functions at seven days, the mean number (95% CI) of problems successfully solved and the number of correct box choices made was higher in the N2O group, P = 0.029. N2O with the limitations of an interim analysis appears to have no harmful effect on cognitive functions (memory/processing speed). It may improve the early recovery process of executive functions. This preliminary finding warrants further investigations.

Clinical Effect of Electroacupuncture Baihui and Neiguan Acupoint on Cognitive Function Recovery in Elderly Patients after General Anesthesia

Objective: To study and analyze the clinical effect of electroacupuncture at Baihui and Neiguan Points on cognitive function recovery of elderly patients after general anesthesia. Methods: The subjects were 80 elderly patients who received general anesthesia from January 2019 to February 2021. According to different anesthesia methods, they were divided into research group (electroacupuncture at Baihui and Neiguan combined with conventional drug anesthesia) and control group (simple drug anesthesia). The postoperative cognitive function recovery of the two groups was observed and compared. Results: Compared with the control group, the MMSE score and POCD incidence of research group were significantly better. There was significant difference between the two groups (P &lt; 0.05). Conclusion: Conclusion electroacupuncture at Baihui and Neiguan combined with conventional drug anesthesia can promote the recovery of cognitive function and prevent cognitive dysfunction in elderly patients under general anesthesia.

The Effect of Supervised Early Resistance Training Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy (SEcReT): A Pilot Randomised Controlled Trial

Post-operative cognitive impairment remains the most prevalent adverse outcome following cardiac surgery. This study aimed to investigate the effects of a 12-week early moderate-intensity resistance training program compared to aerobic-based rehabilitation on post-operative cognitive recovery following cardiac surgery via median sternotomy.

Inhibition of α-Synuclein Accumulation Improves Neuronal Apoptosis and Delayed Postoperative Cognitive Recovery in Aged Mice.

Delayed neurocognitive recovery (dNCR) is a major complication after anesthesia and surgery in older adults. Alpha-synuclein (α-syn; encoded by the gene, SNCA) has recently been shown to play an important role in hippocampus-dependent working memory. Aggregated forms of α-syn are associated with multiple neurotoxic mechanisms, such as mitochondrial dysfunction and cell death. In this study, we found that blocking α-syn improved both mitochondrial function and mitochondria-dependent neuronal apoptosis in a mouse model of dNCR. Various forms of α-syn (including total α-syn, phosphorylated-Ser129-α-syn, and oligomers) were upregulated in hippocampal tissue and extracted mitochondria after surgical challenge. Clenbuterol is a novel transcription modulator of Scna. Clenbuterol significantly attenuated surgery-induced progressive accumulation of various toxic α-syn forms in the hippocampus, as well as mitochondrial damage and memory deficits in aged mice following surgery. We also observed excessive mitochondrial α-syn accumulation and increased mitochondria-mediated apoptosis in vitro using nerve growth factor-differentiated PC12 cells and primary hippocampal neurons exposed to lipopolysaccharide. To further validate the neuroprotective effect of α-syn inhibition, we used a lentiviral Snca-shRNA (Lv-shSnca) to knockdown Snca. Of note, Lv-shSnca transfection significantly inhibited neuronal apoptosis mediated by the mitochondrial apoptosis pathway in neurons exposed to lipopolysaccharide. This α-syn inhibition improved the disruption to mitochondrial morphology and function, as well as decreased levels of apoptosis. Our results suggest that targeting pathological α-syn may achieve neuroprotection through regulation of mitochondrial homeostasis and suppression of apoptosis in the aged hippocampus, further strengthening the therapeutic potential of targeting α-syn for dNCR.