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Ma H, Wei Y, Chen W, Chen S, Wang Y, Cao S, Wang H. Serum proteomics study on cognitive impairment after cardiac valve replacement surgery: a prospective observational study. PeerJ 2024; 12:e17536. [PMID: 38912047 PMCID: PMC11192023 DOI: 10.7717/peerj.17536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The incidence of perioperative neurocognitive disorders (PND) is high, especially after cardiac surgeries, and the underlying mechanisms remain elusive. Here, we conducted a prospective observational study to observe serum proteomics differences in PND patients after cardiac valve replacement surgery. Methods Two hundred and twenty-six patients who underwent cardiac valve surgery were included. They were categorized based on scoring into non-PND group (group non-P) and PND group (group P'). The risk factors associated with PND were analyzed. These patients were further divided into group C and group P by propensity score matching (PSM) to investigate the serum proteome related to the PND by serum proteomics. Results The postoperative 6-week incidence of PND was 16.8%. Risk factors for PND include age, chronic illness, sufentanil dosage, and time of cardiopulmonary bypass (CPB). Proteomics identified 31 down-regulated proteins and six up-regulated proteins. Finally, GSTO1, IDH1, CAT, and PFN1 were found to be associated with PND. Conclusion The occurrence of PND can impact some oxidative stress proteins. This study provided data for future studies about PND to general anaesthesia and surgeries.
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Affiliation(s)
- Huanhuan Ma
- Department of Anesthesiology, Medical College of Soochow University, Soochow, Jiangsu Province, China
- Department of Anesthesiology, Zunyi Maternal and Child Health Care Hospital, Zunyi, Guizhou Province, China
| | - Yiyong Wei
- Department of Anesthesiology, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, Guangdong Province, China
| | - Wei Chen
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Song Chen
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Yan Wang
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Song Cao
- Department of Pain Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong Province, China
| | - Haiying Wang
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
- Department of Anesthesiology, Zunyi Medical University, Zunyi, Guizhou Province, China
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Hight D, Ehrhardt A, Lersch F, Luedi MM, Stüber F, Kaiser HA. Lower alpha frequency of intraoperative frontal EEG is associated with postoperative delirium: A secondary propensity-matched analysis. J Clin Anesth 2024; 93:111343. [PMID: 37995609 DOI: 10.1016/j.jclinane.2023.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a serious complication of surgery, especially in the elderly patient population. It has been proposed that decreasing the amount of anesthetics by titrating to an EEG index will lower POD rate, but clear evidence is missing. A strong age-dependent negative correlation has been reported between the peak oscillatory frequency of alpha waves and end-tidal anesthetic concentration, with older patients generating slower alpha frequencies. We hypothesized, that slower alpha oscillations are associated with a higher rate of POD. METHOD Retrospective analysis of patients` data from a prospective observational study in cardiac surgical patients approved by the Bernese Ethics committee. Frontal EEG was recorded during Isoflurane effect-site concentrations of 0.7 to 0.8 and peak alpha frequency was measured at highest power between 6 and 17 Hz. Delirium was assessed by chart review. Demographic and clinical characteristics were compared between POD and non-POD groups. Selection bias was addressed using nearest neighbor propensity score matching (PSM) for best balance. This incorporated 18 variables, whereas patients with missing variable information or without an alpha oscillation were excluded. RESULT Of the 1072 patients in the original study, 828 were included, 73 with POD, 755 without. PSM allowed 328 patients into the final analysis, 67 with, 261 without POD. Before PSM, 8 variables were significantly different between POD and non-POD groups, none thereafter. Mean peak alpha frequency was significantly lower in the POD in contrast to non-POD group before and after matching (7.9 vs 8.9 Hz, 7.9 vs 8.8 Hz respectively, SD 1.3, p < 0.001). CONCLUSION Intraoperative slower frontal peak alpha frequency is independently associated with POD after cardiac surgery and may be a simple intraoperative neurophysiological marker of a vulnerable brain for POD. Further studies are needed to investigate if there is a causal link between alpha frequency and POD.
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Affiliation(s)
- Darren Hight
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Alexander Ehrhardt
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Hirslanden Clinic Aarau, Center for Anaesthesiology and Intensive Care Medicine, Aarau, Switzerland
| | - Friedrich Lersch
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Markus M Luedi
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Department for Anesthesiology, Intensive, Rescue and Pain medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Frank Stüber
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Heiko A Kaiser
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Hirslanden Clinic Aarau, Center for Anaesthesiology and Intensive Care Medicine, Aarau, Switzerland.
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Potestio CP, Dibato J, Bolkus K, Awad A, Thayasivam U, Patel A, Bright A, Mitrev LV. Post-Operative Cognitive Dysfunction in Elderly Patients Receiving Propofol Sedation for Gastrointestinal Endoscopies: An Observational Study Utilizing Processed Electroencephalography. Cureus 2023; 15:e46588. [PMID: 37933341 PMCID: PMC10625787 DOI: 10.7759/cureus.46588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Propofol sedation is commonly administered during gastrointestinal (GI) procedures. The Patient State Index (PSI) is a processed electroencephalography (EEG) parameter obtained with the SedLine® Sedation Monitoring system (Masimo Corporation, Irvine, CA). When used to objectively assess the patient's level of consciousness, PSI may provide a more effective, safer titration of sedation during GI procedures. We hypothesize that having more or longer episodes of deep sedation as assessed by PSI (i.e., PSI<26) would correlate with developing new-onset or worsening post-operative cognitive dysfunction (POCD). METHODS This was a pragmatic, double-blinded observational study of 400 patients aged ≥65 years undergoing upper GI endoscopy, lower GI endoscopy, or a combined procedure utilizing propofol sedation at a tertiary-care [A1] academic medical center. The patients were monitored with the SedLine® Brain Function Monitor, software version 2 (Masimo Corporation, Irvine, CA), throughout the case, starting at baseline (i.e., before administration of propofol) and stopping at case end. We assessed the subjects' cognitive function via an in-person interview at baseline (pre-procedure) and telephone interviews at 1, 7 (±1), and 90 days after study enrollment. Cognitive function was assessed by administering the short blessed test (SBT), which is a validated brief cognitive screening appropriate for in-person and telephone administration. RESULTS The correlations between the change in SBT score and the pre-defined parameters of PSI were not significant (all p-values >5%). There was a significant drop in SBT scores on day seven. Higher age was also significantly associated with a drop in SBT from baseline. Deep sedation, as evidenced by the number of times PSI was lower than 26, was not predictive of the change in SBT, nor was gender, total propofol dose, or vasoactive drug use during the procedure. CONCLUSIONS The observed incidence of POCD after GI procedures with propofol sedation was low (1.3% at seven days and 2.95% at 90 days) and lower than at the baseline. Age was associated with a greater average decline in SBT score, although the absolute change was small (-0.067 per year of age increase). Deeper sedation, as documented by the PSI score, was not associated with a change in POCD measured with the SBT.
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Affiliation(s)
| | - John Dibato
- Department of Clinical Biostatistics, Cooper Medical School of Rowan University, Camden, USA
| | - Kelly Bolkus
- Department of Anesthesiology, Cooper University Health Care, Camden, USA
| | - Ahmed Awad
- Department of Anesthesiology, Cooper University Hospital, Camden, USA
| | | | - Avish Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, USA
| | - Anshel Bright
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, USA
| | - Ludmil V Mitrev
- Department of Anesthesiology, Cooper University Hospital, Camden, USA
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Li T, Han W, Yang X, Wang Y, Peng L, He L, Hu L, Liu J, Xia M, Wang S. Effects of Different Injection Rates of Propofol on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Inguinal Hernia Repair. Drug Des Devel Ther 2023; 17:1741-1752. [PMID: 37333962 PMCID: PMC10276595 DOI: 10.2147/dddt.s407905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose This study aimed to explore the effects of different injection rates of propofol on postoperative cognition in elderly patients undergoing laparoscopic inguinal hernia repair. Methods A total of 180 elderly patients who planned to undergo laparoscopic inguinal hernia repair were randomly divided into three groups: slow injection of propofol (VS-Group, 30 mg kg-1 h-1); medium injection of propofol (VM-Group, 100 mg kg-1 h-1) or fast injection of propofol (VF-Group, 300 mg kg-1 h-1). Propofol was induced by microinfusion pump, and the depth of anesthesia was monitored by bispectral index (BIS). Propofol and remifentanil were continuously infused during anesthesia maintenance and adjusted according to BIS. The primary outcome was the use of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to measure the incidence of postoperative cognitive decline (POCD) in elderly patients on the first and seventh postoperative day. Secondary outcomes included induced dose of propofol, incidence of burst suppression and maximum electroencephalographic (EEG) effect of propofol (BIS-min) during induction. Results The incidence of POCD on the first and seventh day postoperatively was similar among the three groups (P > 0.05). However, with the increase of propofol injection rate, induced dose of propofol, incidence of burst suppression and BIS-min during induction, the number of patients requiring vasoactive agents were significantly increased (P < 0.001). Multivariate regression analysis showed that the brief duration of burst suppression during induction did not affect the occurrence of POCD, while age and duration of hospitalization were risk factors for POCD. Conclusion For elderly patients undergoing laparoscopic inguinal hernia repair, lowering the injection rate of propofol (such as 30 mg kg-1 h-1) cannot decrease the incidence of early POCD, but reduces induction dose of propofol and use of vasoactive drugs, making the patient's hemodynamics more stable.
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Affiliation(s)
- Tingting Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Wenjing Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
| | - Xinlu Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Yu Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Li Peng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Lingwei He
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Lianjia Hu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Jiayuan Liu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Min Xia
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of China
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Karan N, Bansal S, Mehta UM, Chakrabarti D, Reddy M. Postoperative delayed neurocognitive recovery: Evaluation of its incidence and correlation with intraoperative cerebral desaturation - A prospective observational study. Clin Neurol Neurosurg 2023; 227:107642. [PMID: 36871389 DOI: 10.1016/j.clineuro.2023.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Delayed neurocognitive recovery (DNR) is commonly seen in patients in the postoperative period. Literature has shown that monitoring cerebral desaturation intraoperatively can predict the development of DNR in elderly patients undergoing surgery in prone position. This prospective observational study was conducted in patients of all ages, with the primary objective to determine the incidence of DNR and its correlation with cerebral oximetry. The secondary objectives were to determine if intraoperative cerebral desaturation influenced the neuropsychometric variables from preoperative to postoperative period. METHODS This study included 61 patients, aged > 18 years undergoing spinal surgery in prone position. An evening before surgery and at 48 h postoperatively, patients were subjected to neuropsychological examination; Hindi Mental State Examination, Colour Trail Test 1 (CTT 1), CTT 2, Auditory Verbal Learning (AVLT) tests conducted by principal investigator (PI). DNR was defined as a 20% change in any of the test scores from the baseline. rSO2 was recorded bilaterally every 10 min throughout surgery by an independent person. Cerebral desaturation was defined as a 20% drop in rSO2 from the control value. RESULTS The incidence of DNR was 24.6%. The duration of anesthesia and cerebral desaturation were found to be independently predictive of DNR, with each hour of anesthesia causing a two-fold increase in the chances of development DNR (P = 0.019) and presence of cerebral desaturation causing a 6-fold increase (P = 0.039). CTT 1 and CTT 2 tests had significantly larger increase in test scores in the postoperative period, in patients with cerebral desaturation. CONCLUSION Duration of anesthesia and cerebral desaturation were factors predictive of the development of DNR in patients undergoing spine surgery in prone position.
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Affiliation(s)
- Nupur Karan
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
| | - Urvakhsh Meherwan Mehta
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Madhusudan Reddy
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
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Kim HJ, Kim HR, Kim SY, Kim HY, Park WK, Lee MH, Kim HJ. In response: Letter to the editor in response to the article: "Predictors of difficult intubation when using a videolaryngoscope with an intermediate-angled blade during the first attempt: a prospective observational study". J Clin Monit Comput 2022; 36:1911-1912. [PMID: 35403933 DOI: 10.1007/s10877-022-00862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hye Jin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul, 03722, Republic of Korea
| | - Hye Rim Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul, 03722, Republic of Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul, 03722, Republic of Korea
| | - Min Ho Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul, 03722, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul, 03722, Republic of Korea.
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Horáček M. Monitoring of processed EEG under anesthesia I. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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