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Li Z, Zhu Y, Qin S, Gao X, Kang Y, Li S, Chai J. Effects of permissive hypercapnia on intraoperative cerebral oxygenation and early postoperative cognitive function in older patients with non-acute fragile brain function undergoing laparoscopic colorectal surgery: protocol study. BMC Geriatr 2023; 23:581. [PMID: 37735369 PMCID: PMC10512528 DOI: 10.1186/s12877-023-04125-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Perioperative brain protection in older patients has been the focus of research recently; meanwhile, exploring the relationship between regional cerebral oxygen saturation (rSO2) and brain function in the perioperative period has been an emerging and challenging area-the difficulties related to the real-time monitoring of rSO2 and the choice of feasible interventions. As an advanced instrument for intraoperative rSO2 monitoring, the clinical application of near-infrared spectrum (NIRS) cerebral oxygen monitoring has gradually increased in popularity and is being recognized for its beneficial clinical outcomes in patients undergoing cardiac and noncardiac surgery. In addition, although sufficient evidence to support this hypothesis is still lacking, the effect of permissive hypercapnia (PHC) on rSO2 has expanded from basic research to clinical exploration. Therefore, monitoring intraoperative rSO2 in older patients with NIRS technology and exploring possible interventions that may change rSO2 and even improve postoperative cognitive performance is significant and clinically valuable. METHODS This study is a single-center randomized controlled trial (RCT). 76 older patients are enrolled as subjects. Patients who meet the screening criteria will be randomly assigned 1:1 to the control and intervention groups. PHC-based mechanical ventilation will be regarded as an intervention. The primary outcome is the absolute change in the percent change in rSO2 from baseline to the completion of surgery in the intervention and control groups. Secondary outcomes mainly include observations of intraoperative cerebral oxygenation and metabolism, markers of brain injury, and assessments of patients' cognitive function using scale through postoperative follow-up. DISCUSSION The findings of this RCT will reveal the effect of PHC on intraoperative rSO2 in older patients with nonacute fragile brain function (NFBF) and the approximate trends over time, and differences in postoperative cognitive function outcomes. We anticipate that the trial results will inform clinical policy decision-makers in clinical practice, enhance the management of intraoperative cerebral oxygen monitoring in older patients with comorbid NFBF, and provide guidance for clinical brain protection and improved postoperative cognitive function outcomes. TRIAL REGISTRATION ChiCTR, ChiCTR2200062093, Registered 9/15/2022.
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Affiliation(s)
- Zhichao Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Youzhuang Zhu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shangyuan Qin
- Department of Anesthesiology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xin Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yihan Kang
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
| | - Si Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Chai
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Ju LS, Morey TE, Seubert CN, Martynyuk AE. Intergenerational Perioperative Neurocognitive Disorder. BIOLOGY 2023; 12:biology12040567. [PMID: 37106766 PMCID: PMC10135810 DOI: 10.3390/biology12040567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Accelerated neurocognitive decline after general anesthesia/surgery, also known as perioperative neurocognitive disorder (PND), is a widely recognized public health problem that may affect millions of patients each year. Advanced age, with its increasing prevalence of heightened stress, inflammation, and neurodegenerative alterations, is a consistent contributing factor to the development of PND. Although a strong homeostatic reserve in young adults makes them more resilient to PND, animal data suggest that young adults with pathophysiological conditions characterized by excessive stress and inflammation may be vulnerable to PND, and this altered phenotype may be passed to future offspring (intergenerational PND). The purpose of this narrative review of data in the literature and the authors' own experimental findings in rodents is to draw attention to the possibility of intergenerational PND, a new phenomenon which, if confirmed in humans, may unravel a big new population that may be affected by parental PND. In particular, we discuss the roles of stress, inflammation, and epigenetic alterations in the development of PND. We also discuss experimental findings that demonstrate the effects of surgery, traumatic brain injury, and the general anesthetic sevoflurane that interact to induce persistent dysregulation of the stress response system, inflammation markers, and behavior in young adult male rats and in their future offspring who have neither trauma nor anesthetic exposure (i.e., an animal model of intergenerational PND).
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Affiliation(s)
- Ling-Sha Ju
- Department of Anesthesiology, College of Medicine, University of Florida, P.O. Box 100254, JHMHC, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Timothy E Morey
- Department of Anesthesiology, College of Medicine, University of Florida, P.O. Box 100254, JHMHC, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Christoph N Seubert
- Department of Anesthesiology, College of Medicine, University of Florida, P.O. Box 100254, JHMHC, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Anatoly E Martynyuk
- Department of Anesthesiology, College of Medicine, University of Florida, P.O. Box 100254, JHMHC, 1600 SW Archer Road, Gainesville, FL 32610, USA
- Brain Institute, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Han M, Wu X, Li J, Han S, Rong J. Effects of Remote Ischemic Preconditioning on Postoperative Cognitive Dysfunction in Elderly Patients with Laparoscopic Cholecystectomy. Int J Gen Med 2023; 16:961-971. [PMID: 36959973 PMCID: PMC10027852 DOI: 10.2147/ijgm.s401902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose We hypothesized that remote ischemic preconditioning (RIPC) could improve postoperative cognitive dysfunction (POCD) in elderly patients following laparoscopic cholecystectomy (LC). Patients and Methods Eighty-eight patients were randomly assigned to either the control or the RIPC group. The RIPC was applied on the right upper limb using a blood pressure cuff inflating 200 mmHg, consisting of 3 cycles of 5 min ischemia and 5 min reperfusion. Serum concentrations of Neuron-specific Enolase (NSE) and Brain-Derived Neurotrophic Factor (BDNF) were collected at one-day preoperative (T0), at the end of the operation (T4) and one-day postoperative (T5). Z score was tested at T0 and 3 days after the operation (T6). POCD was determined if there were two Z scores ≥1.96 at the same time or an average Z score ≥1.96. Results There was no significant difference in the Z score of each test between the two groups at T0 (P > 0.05). Notably, the duration of Stroop test C was significantly shorter in the RIPC group than that in the Control group at T6 (P = 0.01). POCD occurred in 1/44 (2.3%) patients in the RIPC group and 8/44 (18.2%) patients in the control group at T6 (P=0.035). In addition, serum NSE concentration was significantly decreased, but serum BDNF concentration was increased compared with the control group at T4 and T5 (P<0.001). Conclusion RIPC could reduce the incidence of POCD in elderly patients after laparoscopic cholecystectomy.
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Affiliation(s)
- Mengnan Han
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate Faculty, Hebei North University, Zhangjiakou, People’s Republic of China
| | - Xiaoqian Wu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Correspondence: Jianli Li, Department of Anesthesiology, Hebei General Hospital, No. 348 West Heping Road, Shijiazhuang, 050051, People’s Republic of China, Tel +86 13785118676, Email
| | - Shuang Han
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Junfang Rong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
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Safavynia SA, Goldstein PA, Evered LA. Mitigation of perioperative neurocognitive disorders: A holistic approach. Front Aging Neurosci 2022; 14:949148. [PMID: 35966792 PMCID: PMC9363758 DOI: 10.3389/fnagi.2022.949148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
William Morton introduced the world to ether anesthesia for use during surgery in the Bullfinch Building of the Massachusetts General Hospital on October 16, 1846. For nearly two centuries, the prevailing wisdom had been that the effects of general anesthetics were rapidly and fully reversible, with no apparent long-term adverse sequelae. Despite occasional concerns of a possible association between surgery and anesthesia with dementia since 1887 (Savage, 1887), our initial belief was robustly punctured following the publication in 1998 of the International Study of Post-Operative Cognitive Dysfunction [ISPOCD 1] study by Moller et al. (1998) in The Lancet, in which they demonstrated in a prospective fashion that there were in fact persistent adverse effects on neurocognitive function up to 3 months following surgery and that these effects were common. Since the publication of that landmark study, significant strides have been made in redefining the terminology describing cognitive dysfunction, identifying those patients most at risk, and establishing the underlying etiology of the condition, particularly with respect to the relative contributions of anesthesia and surgery. In 2018, the International Nomenclature Consensus Working Group proposed new nomenclature to standardize identification of and classify perioperative cognitive changes under the umbrella of perioperative neurocognitive disorders (PND) (Evered et al., 2018a). Since then, the new nomenclature has tried to describe post-surgical cognitive derangements within a unifying framework and has brought to light the need to standardize methodology in clinical studies and motivate such studies with hypotheses of PND pathogenesis. In this narrative review, we highlight the relevant literature regarding recent key developments in PND identification and management throughout the perioperative period. We provide an overview of the new nomenclature and its implications for interpreting risk factors identified by clinical association studies. We then describe current hypotheses for PND development, using data from clinical association studies and neurophysiologic data where appropriate. Finally, we offer broad clinical guidelines for mitigating PND in the perioperative period, highlighting the role of Brain Enhanced Recovery After Surgery (Brain-ERAS) protocols.
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Affiliation(s)
- Seyed A. Safavynia
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States
| | - Peter A. Goldstein
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Lisbeth A. Evered
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States
- Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Lisbeth A. Evered,
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Barbu M, Jónsson K, Zetterberg H, Blennow K, Kolsrud O, Ricksten S, Dellgren G, Björk K, Jeppsson A. Serum biomarkers of brain injury after uncomplicated cardiac surgery: Secondary analysis from a randomized trial. Acta Anaesthesiol Scand 2022; 66:447-453. [PMID: 35118644 PMCID: PMC9302991 DOI: 10.1111/aas.14033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/16/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
Background Postoperative cognitive dysfunction is common after cardiac surgery. Postoperative measurements of brain injury biomarkers may identify brain damage and predict cognitive dysfunction. We describe the release patterns of five brain injury markers in serum and plasma after uncomplicated cardiac surgery. Methods Sixty‐one elective cardiac surgery patients were randomized to undergo surgery with either a dextran‐based prime or a crystalloid prime. Blood samples were taken immediately before surgery, and 2 and 24 h after surgery. Concentrations of the brain injury biomarkers S100B, glial fibrillary acidic protein (GFAP), tau, neurofilament light (NfL) and neuron‐specific enolase (NSE)) and the blood–brain barrier injury marker β‐trace protein were analyzed. Concentrations of brain injury biomarkers were correlated to patients’ age, operation time, and degree of hemolysis. Results No significant difference in brain injury biomarkers was observed between the prime groups. All brain injury biomarkers increased significantly after surgery (tau +456% (25th–75th percentile 327%−702%), NfL +57% (28%−87%), S100B +1145% (783%−2158%), GFAP +17% (−3%−43%), NSE +168% (106%−228%), while β‐trace protein was reduced (−11% (−17−3%). Tau, S100B, and NSE peaked at 2h, NfL and GFAP at 24 h. Postoperative concentrations of brain injury markers correlated to age, operation time, and/or hemolysis. Conclusion Uncomplicated cardiac surgery with cardiopulmonary bypass is associated with an increase in serum/plasma levels of all the studied injury markers, without signs of blood–brain barrier injury. The biomarkers differ markedly in their levels of release and time course. Further investigations are required to study associations between perioperative release of biomarkers, postoperative cognitive function and clinical outcome.
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Affiliation(s)
- Mikael Barbu
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Blekinge Hospital Karlskrona Sweden
| | - Kristján Jónsson
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Department of Neurodegenerative Disease UCL Institute of Neurology London UK
- UK Dementia Research Institute at UCL London UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Mölndal Sweden
| | - Oscar Kolsrud
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Sven‐Erik Ricksten
- Department of Cardiothoracic Anesthesia and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Institute of Clinical Sciences University of Gothenburg Gothenburg Sweden
| | - Göran Dellgren
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Kerstin Björk
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
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Vu T, Smith JA. An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery. Front Psychiatry 2022; 13:884907. [PMID: 35782418 PMCID: PMC9240195 DOI: 10.3389/fpsyt.2022.884907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/23/2022] [Indexed: 12/14/2022] Open
Abstract
Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015-present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.
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Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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Shi H, Du X, Wu F, Hu Y, Xv Z, Mi W. Dexmedetomidine improves early postoperative neurocognitive disorder in elderly male patients undergoing thoracoscopic lobectomy. Exp Ther Med 2020; 20:3868-3877. [PMID: 32855737 PMCID: PMC7444346 DOI: 10.3892/etm.2020.9113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/07/2020] [Indexed: 01/02/2023] Open
Abstract
Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery that frequently occurs in patients ≥65 years. PND includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). To investigate whether intravenous dexmedetomidine (DEX) is able to improve neurocognitive function in elderly male patients following thoracoscopic lobectomy, a randomized, double-blinded, placebo-controlled trial was performed at the Affiliated Hospital of Inner Mongolia Medical University (Hohhot, China). Patients aged ≥65 years were enrolled and were subjected to thoracic surgery under general anesthesia. A computer-generated randomization sequence was used to randomly assign patients (at a 1:1 ratio) to receive either intravenous DEX (0.5 µg/kg per h, from induction until chest closure) or placebo (intravenous normal saline). The primary endpoint was the result of the Mini-Mental State Examination (MMSE). The secondary endpoints were the results of the Montreal Cognitive Assessment (MoCA) and those obtained with the Confusion Assessment Method (CAM), as well as the incidence of POCD and POD during the first 7 postoperative days. Other observational indexes included sleep quality at night, self-anxiety scale prior to the operation and 7 days following the operation and the visual analogue scale (VAS) score at rest and during movement on the first and third day following the operation. Furthermore, at 6 h following surgery, the MMSE score in the DEX group was significantly higher than that in the saline group. At 6 h and on the first day postoperatively, the MoCA score in the DEX group was significantly higher than that in the saline group. The incidence of POCD and POD in the DEX group was 13.2 and 7.5%, respectively, while that in the saline group was 35.8 and 11.3%, respectively. There was a significant difference in the incidence of POCD between the two groups (P<0.01). In the DEX group, mean sleep quality was increased, whereas the mean VAS was decreased compared with the corresponding values in the saline group. In conclusion, elderly male patients who underwent thoracoscopic lobectomy under continuous infusion of DEX (0.5 µg/kg/h) exhibited a reduced incidence of POCD during the first 7 postoperative days as compared with the placebo group. Furthermore, DEX improved the subjective sleep quality in the first postoperative night, reduced anxiety and alleviated postoperative pain. In addition, it increased the incidence of bradycardia. The present study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn; registration no. ChiCTR-IPR-17010958).
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Affiliation(s)
- Haixia Shi
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Xuejiang Du
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Fan Wu
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Yajuan Hu
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Zhipeng Xv
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Weidong Mi
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery-Review. ACTA ACUST UNITED AC 2020; 56:medicina56100493. [PMID: 32987655 PMCID: PMC7598630 DOI: 10.3390/medicina56100493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/16/2022]
Abstract
Postoperative cognitive disorders after cardiac surgery may manifest as postoperative delirium (POD) or later as postoperative cognitive dysfunction (POCD). The incidence of POD after cardiac surgery ranges from 16% to 73%. In contrast to POD, POCD is usually diagnosed after the discharge from hospital, with an incidence of 30 to 70% of cases, very often noticed only by close relative or friends, decreasing after six (20–30%) and twelve (15–25%) months after surgery. Perioperative cognitive disorders are associated with adverse short- and long-term effects, including increased morbidity and mortality. Due to the complexity of delirium pathomechanisms and the difficulties in the diagnosis, researchers have not yet found a clear answer to the question of which patient will be at a higher risk of developing delirium. The risk for POD and POCD in older patients with numerous comorbidities like hypertension, diabetes, and previous ischemic stroke is relatively high, and the predisposing cognitive profile for both conditions is important. The aim of this narrative review was to identify and describe biomarkers used in the diagnosis of delirium after cardiac surgery by presenting a search through studies regarding this subject, which have been published during the last ten years. The authors discussed brain-derived biomarkers, inflammation-related biomarkers, neurotransmitter-based biomarkers, and others. Work based on inflammation-related biomarkers, which are characterized by the low cost of implementation and the effectiveness of delirium diagnosis, seems to be the closest to the goal of discovering an inexpensive and effective marker. Currently, the use of a panel of tests, and not a single biomarker, brings us closer to the discovery of a test, or rather a set of tests ideal for the diagnosis of delirium after cardiac surgery.
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Zbóril S, Schmidt AP, Oses JP, Wiener CD, Portela LV, Souza DO, Auler JOC, Carmona MJC, Fugita MS, Flor PB, Cortopassi SRG. S100B protein and neuron-specific enolase as predictors of postoperative cognitive dysfunction in aged dogs: a case-control study. Vet Anaesth Analg 2020; 47:740-747. [PMID: 32800537 DOI: 10.1016/j.vaa.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative cognitive dysfunction (POCD) may be related to brain injury. S100B protein and neuron-specific enolase (NSE) have been investigated as potential biochemical markers of neural cell injury in animals and humans. This study aimed to investigate the association between POCD, brain injury and serum concentrations of S100B and NSE after periodontal surgery in aged dogs. STUDY DESIGN Prospective observational animal study. ANIMALS A total of 24 male and female dogs undergoing periodontal surgery. METHODS Dogs were separated into two groups based on age: control group, 10 dogs ≤ 8 years and aged group, 14 dogs > 8 years. Cognitive function was measured preoperatively and on the seventh postoperative day using the Canine Cognitive Dysfunction Rating scale and the Age-Related Cognitive and Affective Disorders scale. S100B protein and NSE serum concentrations were measured before and immediately after the surgery. RESULTS POCD was not observed after surgery in the present study. Serum concentrations of S100B and NSE were increased postoperatively in the control group but not in the aged group (p = 0.04 and 0.03, respectively). Preoperative S100B serum concentrations were significantly higher in the aged group (p = 0.01). CONCLUSIONS There was no association between POCD and high concentrations of S100B and NSE in dogs. However, increased postoperative serum concentrations of S100B and NSE were found in the control group after surgery, an effect that may indicate neural damage. CLINICAL RELEVANCE The results suggest that anesthesia and oral surgery are associated with higher postoperative serum concentrations of S100B and NSE in dogs ≤ 8 years old, which may indicate neural damage. Serum concentrations of S100B were elevated in aged dogs before anesthesia, a finding that might be related to chronic preoperative brain damage.
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Affiliation(s)
- Sabrina Zbóril
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - André P Schmidt
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Anesthesia and Perioperative Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil; Department of Anesthesia, Santa Casa de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil; Department of Anesthesia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | - Jean P Oses
- Postgraduate Program in Biochemistry and Molecular Biology, Setor de Bioquímica, Instituto de Biociências, Universidade Federal do Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Carolina D Wiener
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, RS, Brazil
| | - Luis V Portela
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Diogo O Souza
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - José O C Auler
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, SP, Brazil
| | - Maria J C Carmona
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, SP, Brazil
| | - Mariana S Fugita
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Patricia B Flor
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Silvia R G Cortopassi
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Graßler A, Bauernschmitt R, Guthoff I, Kunert A, Hoenicka M, Albrecht G, Liebold A. Effects of pulsatile minimal invasive extracorporeal circulation on fibrinolysis and organ protection in adult cardiac surgery-a prospective randomized trial. J Thorac Dis 2019; 11:S1453-S1463. [PMID: 31293794 DOI: 10.21037/jtd.2019.02.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimal invasive extracorporeal circulation (MiECC) reduces the impact of cardiopulmonary bypass during cardiac surgery on inflammation and hemostasis. Pulsatile perfusion may enhance organ perfusion and help to prevent renal and neuronal damage. The present study investigated the impact of pulsatile MiECC in low-risk coronary artery bypass grafting (CABG) patients. Methods CABG patients were prospectively randomized for non-pulsatile (np: n=19) and pulsatile (p: n=21) MiECC. Blood and urine samples were collected at several time points until 72 h post-operative and analyzed for biochemical markers of fibrinolytic capacity, renal damage, and neuronal damage. Results Although intraoperative tissue plasminogen activator (tPA) levels tended to be higher in the p group, none of the fibrinolysis markers including plasminogen activator inhibitor (PAI-1) and the PAI-1/tPA ratio were significantly affected by pulsation. Hemolysis and markers of renal and neuronal damage were comparable between groups. Intraoperative urinary excretion [np: 400 mL (355 to 680) vs. p: 530 mL (360 to 900)] and cumulative 24 h volume intake [np: 7,090 mL (5,492 to 7,544) vs. p: 7,155 mL (6,682 to 8,710)] were increased by pulsation whereas blood losses up to 12 h post-operative [np: 365 mL (270 to 515) vs. p: 310 mL (225 to 470)] and up to 24 h post-operative [np: 760 mL (555 to 870) vs. p: 520 mL (460 to 670)] were attenuated. Conclusions The present study did not find evidence for a beneficial effect of pulsation on markers of fibrinolysis, renal damage, and neuronal damage. However, pulsatile perfusion increased intraoperative urinary secretion and reduced post-operative blood losses.
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Affiliation(s)
- Angelika Graßler
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.,RoMed Clinical Center Rosenheim, Department of Internal Medicine III, Rosenheim, Germany
| | - Robert Bauernschmitt
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.,MediClin Herzzentrum, Department of Cardiothoracic and Vascular Surgery, Lahr, Germany
| | - Irene Guthoff
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Andreas Kunert
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Günter Albrecht
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
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Di C, Zeng Y, Mao J, Shen Z, Gu W. Dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein in patients with delayed encephalopathy after acute carbon monoxide poisoning. Pak J Med Sci 2018; 34:945-949. [PMID: 30190758 PMCID: PMC6115593 DOI: 10.12669/pjms.344.15363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To study the dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein (GFAP) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods: This study was conducted among DEACMP patients who were hospitalized from November 2014 to February 2016. Serum levels of S100B and GFAP in 66 DEACMP patients were measured by ELISA. Changes in patient states were examined dynamically using activities of daily living (ADL) scale, information-memory-concentration test (IMCT) and Hasegawa’s dementia scale (HDS), and compared with those of 64 patients without DE after ACMP. Results: Serum S100B [(0.59 ± 0.11) ng/ml] and GFAP [(227.67 ± 12.43) ng/ml] levels of DEACMP group in acute phase were significantly higher than those of ACMP group [(0.48 ± 0.10) ng/ml and (178.91 ± 11.47) ng/ml] and DEACMP group in recovery phase [(0.49 ± 0.12) ng/ml and (179.54 ± 12.32) ng/ml] (all P<0.05). Serum S100B and GFAP levels of DEACMP group were significantly correlated in both acute and recovery phases (r=0.432 in acute phase, P=0.007; r=0.378 in recovery phase, P=0.034). ADL, HDS and IMCT scores of DEACMP group in acute phase were (45.12 ± 3.12), (7.98 ± 1.02) and (9.61 ± 1.41) points respectively, which were significantly different from those of recovery phase [(33.25 ± 3.09), (16.13 ± 1.17) and (19.54 ± 1.43) points respectively] (P<0.05). Conclusions: DEACMP was accompanied by secondary brain injury, for which glial activation may be important. Serum S100B and GFAP levels may be related to prognosis.
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Affiliation(s)
- Chong Di
- Chong Di, Emergency Center, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
| | - Yun Zeng
- Yun Zeng, Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, Jiangsu Province, China Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine (TCM) Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jingyu Mao
- Jingyu Mao, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine (TCM) Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhengjie Shen
- Zhengjie Shen, Medical Oncology of Zhangjiagang First People's Hospital, Zhangjiagang 215600, Jiangsu Province, China
| | - Wenzhe Gu
- Wenzhe Gu, Depr. of Otorhinolaryngology, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
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12
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Kumpaitiene B, Svagzdiene M, Drigotiene I, Sirvinskas E, Sepetiene R, Zakelis R, Benetis R. Correlation among decreased regional cerebral oxygen saturation, blood levels of brain injury biomarkers, and cognitive disorder. J Int Med Res 2018; 46:3621-3629. [PMID: 29896989 PMCID: PMC6136023 DOI: 10.1177/0300060518776545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This study was performed to investigate the correlation among decreased
regional cerebral oxygen saturation (rSO2), blood levels of brain
injury biomarkers, and postoperative cognitive disorder (POCD) after cardiac
surgery with cardiopulmonary bypass (CPB). Methods This prospective observational study included 59 patients undergoing coronary
artery bypass graft surgery with CPB. All patients underwent
neuropsychological tests (Mini Mental State Evaluation, Rey Auditory Verbal
Learning Test, digit span test, digit symbol substitution test, and Schulte
table) the day before and 10 days after the surgery. The blood levels of two
brain injury biomarkers, neuron-specific enolase (NSE) and glial fibrillary
acidic protein (GFAP), were measured before and 1 day after the surgery. Results The rSO2 decreased during surgery in 21 (35%) patients. POCD was
detected in 22 (37%) patients. After the surgery, no significant changes in
the GFAP blood level occurred in any patients. No significant correlations
were found among the decreased rSO2, increased NSE blood level,
and rate of POCD. Conclusion These results suggest that a decrease in rSO2 during cardiac
surgery is not necessarily related to the development of POCD or an
increased blood level of the brain injury biomarker NSE.
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Affiliation(s)
| | - Milda Svagzdiene
- 2 Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ingrida Drigotiene
- 3 Kaunas Klinikos, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edmundas Sirvinskas
- 2 Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramune Sepetiene
- 2 Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rolandas Zakelis
- 4 Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Rimantas Benetis
- 2 Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Chen F, Duan G, Wu Z, Zuo Z, Li H. Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis. BMJ Open 2017; 7:e014629. [PMID: 29025825 PMCID: PMC5652618 DOI: 10.1136/bmjopen-2016-014629] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Neurological dysfunction remains a devastating postoperative complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and previous studies have shown that inhalation anaesthesia and total intravenous anaesthesia (TIVA) may produce different degrees of cerebral protection in these patients. Therefore, we conducted a systematic literature review and meta-analysis to compare the neuroprotective effects of inhalation anaesthesia and TIVA. DESIGN Searching in PubMed, EMBASE, Science Direct/Elsevier, China National Knowledge Infrastructure and Cochrane Library up to August 2016, we selected related randomised controlled trials for this meta-analysis. RESULTS A total of 1485 studies were identified. After eliminating duplicate articles and screening titles and abstracts, 445 studies were potentially eligible. After applying exclusion criteria (full texts reported as abstracts, review article, no control case, lack of outcome data and so on), 13 studies were selected for review. Our results demonstrated that the primary outcome related to S100B level in the inhalation anaesthesia group was significantly lower than in the TIVA group after CPB and 24 hours postoperatively (weighted mean difference (WMD); 95% CI (CI): -0.41(-0.81 to -0.01), -0.32 (-0.59 to -0.05), respectively). Among secondary outcome variables, mini-mental state examination scores of the inhalation anaesthesia group were significantly higher than those of the TIVA group 24 hours after operation (WMD (95% CI): 1.87 (0.82 to 2.92)), but no significant difference was found in arteriovenous oxygen content difference, cerebral oxygen extraction ratio and jugular bulb venous oxygen saturation, which were assessed at cooling and rewarming during CPB. CONCLUSION This study demonstrates that anaesthesia with volatile agents appears to provide better cerebral protection than TIVA for patients undergoing cardiac surgery with CPB, suggesting that inhalation anaesthesia may be more suitable for patients undergoing cardiac surgery.
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Affiliation(s)
- Feng Chen
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Issitt RW, Harvey I, Walsh B, Voegeli D. Quantification of Lipid Filtration and the Effects on Cerebral Injury During Cardiopulmonary Bypass. Ann Thorac Surg 2017; 104:884-890. [DOI: 10.1016/j.athoracsur.2017.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
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Öztürk S, Saçar M, Baltalarlı A, Öztürk İ. Effect of the type of cardiopulmonary bypass pump flow on postoperative cognitive function in patients undergoing isolated coronary artery surgery. Anatol J Cardiol 2016; 16:875-880. [PMID: 27163534 PMCID: PMC5324892 DOI: 10.14744/anatoljcardiol.2015.6572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Pulsatile flow, generated by a pump during cardiopulmonary bypass, has been accepted as more physiological in coronary artery bypass grafting surgery (CABG). Therefore, we aimed to investigate the effects of pulsatile and nonpulsatile flow on postoperative cognitive function and to review relationship with the biomarkers S100ß and neuron-specific enolase (NSE). METHODS Patients who underwent isolated CABG were included this prospective, randomized, double-blind study, which was performed between March 2010 and December 2010. Patients were divided into two groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow. Blood samples were collected 1 day before surgery and in the sixth postoperative hour for the analysis of S100ß and NSE. In addition, Mini-Mental State Examination (MMSE) was performed during preoperative period and on third postoperative day. Outcomes were determination of effects of pump flow type on cognitive function and relationships with concentrations of S100ß and NSE. RESULTS Forty patients were included. No differences were observed between the groups with respect to complications, mortality, S100ß (Group I: 1.9±0.2 µ/L; Group II: 2.0±0.2 µ/L), NSE (Group I: 12.5±0.8 µ/L; Group II: 12.4±0.7 µ/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was observed between MMSE scores and concentrations of S100ß (r=-0.032) and NSE (r=-0.423) (p>0.05). CONCLUSION There was no difference between types of pump flow for POCD and no relationship between cognitive dysfunction and S100ß and NSE concentrations. Pump flow type does not affect NSE concentrations.
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Affiliation(s)
- Selen Öztürk
- Dr. Siyami Ersek Cardiothoracic and Vascular Surgery Education and Research Hospital, Department of Cardiovascular Surgery, İstanbul-Turkey.
| | - Mustafa Saçar
- 18 Mart Univesity, Faculty of Medicine, Department of Cardiovascular Surgery, Çanakkale-Turkey
| | - Ahmet Baltalarlı
- Pamukkale Univesity, Faculty of Medicine, Department of Cardiovascular Surgery, Denizli-Turkey
| | - İbrahim Öztürk
- Göztepe Education and Research Hospital, Department of Anesthesiology, İstanbul-Turkey
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Hernández-García C, Rodríguez-Rodríguez A, Egea-Guerrero J. Brain injury biomarkers in the setting of cardiac surgery: Still a world to explore. Brain Inj 2015; 30:10-7. [DOI: 10.3109/02699052.2015.1079733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review. Cardiovasc Psychiatry Neurol 2015; 2015:370612. [PMID: 26491558 PMCID: PMC4605208 DOI: 10.1155/2015/370612] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022] Open
Abstract
Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.
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Rathbone ATL, Tharmaradinam S, Jiang S, Rathbone MP, Kumbhare DA. A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the "post-inflammatory brain syndrome" PIBS. Brain Behav Immun 2015; 46:1-16. [PMID: 25736063 DOI: 10.1016/j.bbi.2015.02.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 12/22/2022] Open
Abstract
Post-concussion syndrome is an aggregate of symptoms that commonly present together after head injury. These symptoms, depending on definition, include headaches, dizziness, neuropsychiatric symptoms, and cognitive impairment. However, these symptoms are common, occurring frequently in non-head injured controls, leading some to question the existence of post-concussion syndrome as a unique syndrome. Therefore, some have attempted to explain post-concussion symptoms as post-traumatic stress disorder, as they share many similar symptoms and post-traumatic stress disorder does not require head injury. This explanation falls short as patients with post-concussion syndrome do not necessarily experience many key symptoms of post-traumatic stress disorder. Therefore, other explanations must be sought to explain the prevalence of post-concussion like symptoms in non-head injury patients. Many of the situations in which post-concussion syndrome like symptoms may be experienced such as infection and post-surgery are associated with systemic inflammatory responses, and even neuroinflammation. Post-concussion syndrome itself has a significant neuroinflammatory component. In this review we examine the evidence of neuroinflammation in post-concussion syndrome and the potential role systemic inflammation plays in post-concussion syndrome like symptoms. We conclude that given the overlap between these conditions and the role of inflammation in their etiologies, a new term, post-inflammatory brain syndromes (PIBS), is necessary to describe the common outcomes of many different inflammatory insults. The concept of post-concussion syndrome is in its evolution therefore, the new term post-inflammatory brain syndromes provides a better understanding of etiology of its wide-array of symptoms and the wide array of conditions they can be seen in.
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Affiliation(s)
| | - Surejini Tharmaradinam
- Division of Pediatric Neurology, Department of Pediatrics, McMaster Children's Hospital, Pediatric Neurology, MUMC 3A, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Shucui Jiang
- Division of Neurosurgery, Department of Surgery, and Hamilton Neurorestorative Group, McMaster University, HSC 4E15, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Michel P Rathbone
- Department of Medicine, Division of Neurology, McMaster University - Juravinski Hospital, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Dinesh A Kumbhare
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, University Health Network - Toronto Rehab - University Centre, 550 University Ave, Toronto, Ontario M5G 2A2, Canada
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Yuan SM. S100 and S100β: biomarkers of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass. Braz J Cardiovasc Surg 2014; 29:630-41. [PMID: 25714218 PMCID: PMC4408827 DOI: 10.5935/1678-9741.20140084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/22/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present study is to describe the clinical impact of S100 and S100β for the evaluation of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass (CPB). METHODS Quantitative results of S100 and S100β reported in the literature of the year range 1990-2014 were collected, screened and analyzed. RESULTS Cerebrospinal fluid and serum S100 levels showed a same trend reaching a peak at the end of CPB. The cerebrospinal fluid/serum S100 ratio decreased during CPB, reached a nadir at 6 h after CPB and then increased and kept high untill 24 h after CPB. Serum S100 at the end of CPB was much higher in infant than in adults, and in on-pump than in off-pump coronary artery bypass patients. ∆S100 increased with age and CPB time but lack of statistical significances. Patients receiving an aorta replacement had a much higher ∆S100 than those receiving a congenital heart defect repair. Serum S100β reached a peak at the end of CPB, whereas cerebrospinal fluid S100 continued to increase and reached a peak at 6 h after CPB. The cerebrospinal fluid/serum S100β ratio decreased during CPB, increased at the end of CPB, peaked 1 h after CPB, and then decreased abruptly. The increase of serum S100β at the end of CPB was associated with type of operation, younger age, lower core temperature and cerebral damages. ∆S100β displayed a decreasing trend with age, type of operation, shortening of CPB duration, increasing core temperature, lessening severity of cerebral damage and the application of intervenes. Linear correlation analysis revealed that serum S100β concentration at the end of CPB correlated closely with CPB duration. CONCLUSION S100 and S100β in cerebrospinal fluid can be more accurate than in the serum for the evaluations of cerebral damage in cardiac surgery. However, cerebrospinal fluid biopsies are limited. But serum S100β and ∆S100β seem to be more sensitive than serum S100 and ∆S100. The cerebral damage in cardiac surgery might be associated with younger age, lower core temperature and longer CPB duration during the operation. Effective intervenes with modified CPB circuit filters or oxygenators and supplemented anesthetic agents or priming components may alleviate the cerebral damage.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian
Medical University
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20
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Jones EL, Gauge N, Nilsen OB, Lowery D, Wesnes K, Katsaiti E, Arden J, Amoako D, Prophet N, Purushothaman B, Green D, Ballard C. Analysis of neuron-specific enolase and S100B as biomarkers of cognitive decline following surgery in older people. Dement Geriatr Cogn Disord 2013. [PMID: 23208248 DOI: 10.1159/000345538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Post-operative cognitive decline is frequent in older individuals following major surgery; however, biomarkers of this decline are less clearly defined. METHODS Sixty-eight participants over the age of 60 provided blood samples at baseline and 24 h post-surgery. Cognitive decline was measured at baseline and 52 weeks post-surgery using the Cambridge Assessment for Mental Disorder in the Elderly, section B (CAMCOG) score. Plasma levels of neuron-specific enolase (NSE) and S100B were measured by ELISA. RESULTS Baseline NSE and the change in NSE levels between baseline and 24 h were correlated with the change in CAMCOG score between baseline and 52 weeks. CONCLUSION NSE concentrations may be a useful predictor of individuals at risk of more severe long-term cognitive decline.
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Affiliation(s)
- Emma L Jones
- Wolfson Centre for Age-Related Disease, King's College London, Guy's Campus, London, UK.
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Poullis M, Palmer K, Al-Rawi O, Johnson I, Ridgeway T. Pressure and oxygen debt on bypass - potential quality markers of perfusion? Perfusion 2012; 27:244-8. [PMID: 22547640 DOI: 10.1177/0267659112439085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
No markers of quality of perfusion pressure and oxygen delivery during cardiopulmonary bypass (CPB), to complement rewarming rate, maximum temperature on rewarming, lowest haematocrit, and blood glucose, exist. Using the electronic acquisition of blood pressure on bypass (JOCAP system), the percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, median, mode, standard deviation, variance, and average, maximum and cumulative oxygen debt were calculated. Numerous different readouts of achievement of maintenance of constant pressure on bypass and oxygen debt are now easily achievable with perfusion electronic data management systems. Mean, median, and mode offer poor discrimination of pressure control during CPB. Percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, and standard deviation all have discriminatory power, but need clinical correlation for their significance. A composite score involving non-pressure readouts (e.g. oxygen delivery, arterial and venous saturations, and flow rates) may need to be integrated into any perfusion quality marker. Assessment of adequacy of constant perfusion pressure and oxygen delivery may allow the scientific evaluation of pressure and oxygen delivery on bypass for patients to be compared accurately. Currently, in studies involving CPB, blood pressure targets are stated with no quantitative assessment of adequacy of achievement of these targets. Electronic data monitoring during cardiopulmonary bypass, when correlated with clinical outcome, may help to provide a marker of quality of perfusion pressure during CPB and may, indeed, allow patient-specific perfusion pressure strategies to be developed.
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Affiliation(s)
- Mike Poullis
- Liverpool Heart and Chest Hospital, Liverpool, UK.
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Creagh-Brown BC, Quinlan GJ, Evans TW, Burke-Gaffney A. The RAGE axis in systemic inflammation, acute lung injury and myocardial dysfunction: an important therapeutic target? Intensive Care Med 2010; 36:1644-1656. [PMID: 20631986 DOI: 10.1007/s00134-010-1952-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 05/25/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND The sepsis syndromes, frequently complicated by pulmonary and cardiac dysfunction, remain a major cause of death amongst the critically ill. Targeted therapies aimed at ameliorating the systemic inflammation that characterises the sepsis syndromes have largely yielded disappointing results in clinical trials. Whilst there are many potential reasons for lack of success of clinical trials, one possibility is that the pathways targeted, to date, are only modifiable very early in the course of the illness. More recent approaches have therefore attempted to identify pathways that could offer a wider therapeutic window, such as the receptor for advanced glycation end-products (RAGE) and its ligands. PURPOSE The objectives of this study were to review the evidence supporting the role of the RAGE axis in systemic inflammation and associated acute lung injury and myocardial dysfunction, to explore some of the problems and conflicts that these RAGE studies have raised and to consider strategies by which they might be resolved. METHODS MEDLINE was searched (1990-2010) and relevant literature collected and reviewed. RESULTS AND CONCLUSION RAGE is an inflammation-perpetuating receptor with a diverse range of ligands. Evidence supporting a role of the RAGE axis in the pathogenesis of systemic inflammation, ALI and myocardial dysfunction is compelling with numerous animal experiments showing the beneficial effects of inhibiting the RAGE axis. Despite a number of unanswered questions that need to be further addressed, the potential for inhibiting RAGE-mediated inflammation in humans undoubtedly exists.
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Affiliation(s)
- Benedict C Creagh-Brown
- Unit of Critical Care, Respiratory Science, National Heart and Lung Institute Division, Faculty of Medicine, Imperial College, London, UK
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Neuron-specific enolase and S 100B protein as predictors of outcome in ischaemic stroke. Neurol Neurochir Pol 2010; 44:459-63. [DOI: 10.1016/s0028-3843(14)60136-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jugular Venous Neurone Specific Enolase (NSE) Increases Following Carotid Endarterectomy Under General, but Not Local, Anaesthesia. Eur J Vasc Endovasc Surg 2009; 38:262-6. [DOI: 10.1016/j.ejvs.2009.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 05/13/2009] [Indexed: 11/21/2022]
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Physiopathologie de la dysfonction cognitive postopératoire du sujet âgé : hypothèses actuelles. ACTA ACUST UNITED AC 2008; 145:323-30. [DOI: 10.1016/s0021-7697(08)74310-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ille R, Lahousen T, Schweiger S, Hofmann P, Kapfhammer HP. Influence of patient-related and surgery-related risk factors on cognitive performance, emotional state, and convalescence after cardiac surgery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2007; 8:166-9. [PMID: 17765645 DOI: 10.1016/j.carrev.2006.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 12/12/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac surgery may account for complications such as cognitive impairment, depression, and delay of convalescence. This study investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence. METHODS We included 83 patients undergoing cardiac surgery who had no indication of postoperative delirium. Psychometric testing was performed 1 day before and 7 days after surgery. Neuron-specific enolase (NSE) levels were measured 1 day before and 36 h after surgery. RESULTS Depression score increased after surgery, but patients showed no clinically significant depression. Postoperative cognitive performance correlated with postoperative depression level and preoperative cognitive performance. Forty-three percent of patients showed postoperative decline. Older patients exhibited a higher postoperative increase in NSE concentrations. Patients undergoing coronary artery bypass grafts or combined procedures exhibited more medical risk factors than those undergoing valve surgery alone. The number of bypass grafts was associated with time of hospitalization, and the number of patient-related risk factors correlated with stay in intensive care unit. CONCLUSIONS For elderly patients undergoing cardiac surgery, older age, total preexisting medical risk factors, and surgery duration seem to be the most important factors influencing cognitive outcome and convalescence. Results show that, also for patients without postoperative delirium, medical risk factors and intraoperative parameters can result in delay of convalescence.
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Bergh CD, Bäckström M, Axelsson K, Jönsson H, Johnsson P. Protein S100B after cardiac surgery: an indicator of long-term anxiety? SCAND CARDIOVASC J 2007; 41:109-13. [PMID: 17454836 DOI: 10.1080/14017430601024269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of the study was to assess long-term state and trait anxiety in cardiac surgical risk patients. DESIGN Thirty two patients with serum S100B>0.3 microg/l 48 hours after cardiac surgery with cardiopulmonary bypass were matched according to age, gender, type, date and length of surgery with 35 operated patients without elevated S100B. They completed Spielberger's Anxiety Inventory (STAI). RESULTS Patients with elevated S100B reported more state anxiety and trait anxiety. S100B was an independent predictor of both state and trait anxiety when controlling for perioperative variables. CONCLUSIONS Patients with elevated S100B reported more anxiety 3-6 years after cardiac surgery. A postoperative blood sample can identify risk patients and facilitate appropriate follow-up.
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Sheikh AM, Barrett C, Villamizar N, Alzate O, Miller S, Shelburne J, Lodge A, Lawson J, Jaggers J. Proteomics of cerebral injury in a neonatal model of cardiopulmonary bypass with deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2006; 132:820-8. [PMID: 17000293 DOI: 10.1016/j.jtcvs.2006.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 07/11/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Concern over neurologic injury limits safe duration of deep hypothermic circulatory arrest (DHCA) in surgery for congenital cardiac disease. Proteomics is a novel and powerful technique to study global protein changes in a given protein system. Using a neonatal model of cardiopulmonary bypass with DHCA, we sought to characterize the protein changes associated with DHCA brain injury. METHODS Ten neonatal piglets were randomized to cardiopulmonary bypass with DHCA or sham operation. DHCA animals underwent induction of bypass (100 mL x kg(-1) x min(-1)), cooling to 18 degrees C, then DHCA for 60 minutes. Animals were rewarmed to normothermia, weaned from bypass, and harvested after 30 minutes off bypass. Sham animals underwent sternotomy without further instrumentation. Plasma samples were taken before bypass and before harvest. Proteins differentially expressed in the cerebral neocortex between the 2 groups were determined by 2-dimensional differential gel electrophoresis using fluorescent cyanine dyes and mass spectrometry. A second group of 4 piglets were similarly randomized and, after the experiment, tissues underwent perfusion-fixation for histologic examination. RESULTS Cardiopulmonary bypass with DHCA caused extensive histologic and ultrastructural cerebral injury. Proteomic analysis of cerebral cortex found 10 protein spots to be differentially expressed; 9 were identified by mass spectrometry to represent 6 proteins, including apolipoprotein A-1, neurofilament-M protein, and enolase. Decreased expression of plasma apolipoprotein A-1 was found in DHCA. CONCLUSIONS The acute protein changes associated with cerebral injury in a neonatal model of cardiopulmonary bypass with DHCA have been characterized. These may direct further research aimed at attenuating injury seen from cardiopulmonary bypass with DHCA.
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Affiliation(s)
- Amir M Sheikh
- Department of Pediatric Cardiac Surgery, the Neuroproteomics Center, Duke University Medical Center, Durham, NC, USA.
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Weigl M, Moritz A, Steinlechner B, Schmatzer I, Mora B, Fakin R, Zimpfer D, Ankersmit HJ, Khazen C, Dworschak M. Neuronal Injury After Repeated Brief Cardiac Arrests During Internal Cardioverter Defibrillator Implantation Is Associated With Deterioration of Cognitive Function. Anesth Analg 2006; 103:403-9, table of contents. [PMID: 16861424 DOI: 10.1213/01.ane.0000226088.59744.3e] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test and the forward and backward Digit Span tests were used and P300 latencies were determined preoperatively and postoperatively. Serum neuron-specific enolase (NSE) was determined before and at the end of, as well as 2, 6, and 24 h after surgery. Preoperatively, PM patients scored worse in the Digit Span backward and the Trailmaking tests and showed prolonged P300 latencies. Postoperatively, the Digit Span backward scores declined and NSE levels increased only in the ICD group (P < or = 0.05). The difference between preoperative and postoperative Digit Span backward scores correlated with the increase in serum NSE levels (r2 = 0.3, P < or = 0.05). Moreover, P300 latencies increased in 13 of 17 ICD patients, but decreased in 7 of 10 PM patients (P < or = 0.05). PM patients even improved in the Trailmaking test (P < or = 0.05). Neuronal injury from even brief periods of global brain ischemia seems to be associated with deteriorating neurocognitive function.
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Affiliation(s)
- Manuela Weigl
- Department of Anesthesiology and General Intensive Care, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, University Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Zhang TJ, Hang J, Wen DX, Hang YN, Sieber FE. Hippocampus bcl-2 and bax expression and neuronal apoptosis after moderate hypothermic cardiopulmonary bypass in rats. Anesth Analg 2006; 102:1018-25. [PMID: 16551891 DOI: 10.1213/01.ane.0000199221.96250.8c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using a rat model of moderate hypothermic (26 degrees C-28 degrees C) cardiopulmonary bypass (CPB) with hemodilution, we investigated hippocampal apoptotic gene expression and neuronal apoptosis up to 6 h after CPB. The CPB was performed on male rats (380-400 g) under general anesthesia with isoflurane and fentanyl. The right atrium and tail artery were cannulated, and a peristaltic pump and membrane oxygenator were used for CPB. Two groups were studied: Group 1 consisted of fasted rats (n = 15) subjected to 60 min of moderate hypothermic nonpulsatile CPB; Group 2 consisted of sham-operated rats (n = 15). At 1 h after CPB, in 6 rats per group, hippocampus was processed for the apoptotic gene (bcl-2 and bax) messenger RNAs detection by reverse transcriptase polymerase chain reaction, and messenger RNA expression was determined by the ratio of the polymerase chain reaction product of bcl-2 or bax to the beta-actin gene. At 6 h after CPB, in 6 rats per group, hippocampus expression of Bcl-2 and bax protein was determined by immunohistochemistry, and neuronal apoptosis was detected by TUNEL. At 6 h after CPB, in three rats per group, changes in hippocampal CA1 neuronal ultra structure were determined with electron microscopy. Group 1 had increased ratios of bcl-2/beta-actin, bax/beta-actin, and bax/bcl-2 mRNA at 1 h after CPB (bcl-2/beta-actin, 0.82 +/- 0.14 versus 0.63 +/- 0.07; P = 0.03; bax/beta-actin, 1.04 +/- 0.14 versus 0.56 +/- 0.03; P = 0.00; bax/bcl-2, 1.31 +/- 0.12 versus 0.84 +/- 0.09; P = 0.02; Group 1 versus Group 2, respectively). Group 1 had increased bcl-2 and bax protein expression in hippocampal CA1 region at 6 h after CPB (bcl-2, 0.18 +/- 0.05 versus 0.09 +/- 0.01; P = 0.02; bax, 0.20 +/- 0.06 versus 0.04 +/- 0.02; P = 0.01; Group 1 versus Group 2, respectively). Group 1 had increased TUNEL staining in hippocampus CA1 at 6 h after CPB (0.14 +/- 0.02 versus 0.03 +/- 0.01; P = 0.00; Group 1 versus Group 2, respectively). In Group 1 CA1 hippocampus neurons, ultra-structural changes consistent with apoptosis occurred. In rats, moderate hypothermic CPB with hemodilution is associated with CA1 hippocampus bax and bcl-2 gene expression and neuronal apoptosis during the early post-CPB recovery period.
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Affiliation(s)
- Ting-Jie Zhang
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Second Medicine University, China
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Lewis MS, Maruff P, Silbert BS, Evered LA, Scott DA. The sensitivity and specificity of three common statistical rules for the classification of post-operative cognitive dysfunction following coronary artery bypass graft surgery. Acta Anaesthesiol Scand 2006; 50:50-7. [PMID: 16451151 DOI: 10.1111/j.1399-6576.2006.00893.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The application of statistical rules to determine post-operative cognitive dysfunction (POCD) has varied, and partially explains the wide range of reported incidences of POCD in the literature. The current study assessed the sensitivity and specificity of three commonly used statistical rules in a sample of coronary artery bypass graft (CABG) patients and healthy non-surgical controls. METHODS Two hundred and four CABG patients [mean age, 68.8 years; standard deviation (SD), 7.0 years] completed neuropsychological assessment pre-operatively (baseline) and 1 week and 3 months post-operatively. Ninety age- and gender-matched non-surgical controls (mean age, 67.8 years; SD, 7.9 years) completed the same tasks at the same time points. POCD was determined in each group using three rules: the 1SD decline on two or more tasks; the 20% decline on 20% of tasks rule; and a modified reliable change index. RESULTS The modified reliable change index demonstrated the greatest combination of sensitivity and specificity. The 20% decline on 20% of tasks rule detected the largest incidence of impairment in the CABG group, but showed large incidences of false positive classifications in the control group. The 1SD rule detected the lowest incidence of POCD in the CABG group, but detected a larger incidence of impairment in the control group. CONCLUSIONS The use of the modified reliable change index is recommended, given the sensitivity to change it displayed and the low rates of false positive classification in the control sample. The use of control groups in future research is also recommended.
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Affiliation(s)
- M S Lewis
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St. Vincent's Hospital, and School of Psychological Science, La Trobe University, Melbourne, Vic., Australia.
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Ilcol YO, Basagan-Mogol E, Cengiz M, Ulus IH. Elevation of serum cerebral injury markers correlates with serum choline decline after coronary artery bypass grafting surgery. Clin Chem Lab Med 2006; 44:471-8. [PMID: 16599843 DOI: 10.1515/cclm.2006.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe aims of this study were to determine circulating choline status and its relationship to circulating levels of S-100β protein and neuron-specific enolase, biochemical markers of cerebral injury and cognitive decline, after coronary artery bypass grafting (CABG) surgery. Preoperatively, patients scheduled for off-pump or on-pump CABG surgery had serum concentrations of 12.0±0.2 and 11.7±0.4μmol/L free choline and 2640±65 and 2675±115μmol/L phospholipid-bound choline, respectively. Serum free and bound choline levels decreased by 22–37% or 34–47% and 16–36% or 31–38% at 48h after off-pump or on-pump surgery, respectively. Serum S-100β and neuron-specific enolase increased from preoperative values of 0.083±0.009 and 6.3±0.2μg/L to 0.405±0.022 and 11.4±0.8μg/L, respectively, at 0h postoperatively and remained elevated for 48h after off-pump surgery. Serum free and bound choline concentrations were inversely correlated with the concentrations of S-100β (r=−0.798; p<0.001 and r=−0.734; p<0.001) and neuron-specific enolase (r=−0.840; p<0.001 and r=−0.728; p<0.001). In conclusion, CABG surgery induces a decline in serum free and phospholipid-bound choline concentrations. The decreased serum choline concentrations were inversely correlated with the elevated levels of circulating cerebral injury markers. Thus, a decline in circulating choline may be involved in postoperative cognitive decline.
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Affiliation(s)
- Yesim Ozarda Ilcol
- Department of Biochemistry, Uludag University Medical School, Bursa, Turkey
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Gao L, Taha R, Gauvin D, Othmen LB, Wang Y, Blaise G. Postoperative Cognitive Dysfunction After Cardiac Surgery. Chest 2005; 128:3664-70. [PMID: 16304328 DOI: 10.1378/chest.128.5.3664] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Prolonged postoperative cognitive dysfunction (POCD) is reported to occur frequently after cardiac surgery. However, it is rarely assessed in routine clinical practice and receives little attention. Although the cerebral consequences of cardiopulmonary bypass have been measured clinically, insights into the resulting molecular and pathologic events within the brain have only begun to be investigated. POCD is likely to impair quality of life and constitutes a large burden on society when elderly patients prematurely lose their independence. Numerous studies have reported that neurocognitive deficit is associated with heightened mortality, increased length of hospital stay, and discharge to a nursing home. This is linked with a tremendous demand for health-care resources. Because of the magnitude of the clinical problem, serious consideration must be directed toward understanding its etiology and the development of neuroprotective strategies. Clearly identifying the mechanisms of POCD is challenging. The purpose of this review is to discuss recent developments in our understanding of the pathophysiologic mechanisms, prevention, and treatments that have been designed to ameliorate brain dysfunction after cardiac surgery.
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Affiliation(s)
- Lan Gao
- Laboratory of Anesthesia, Department of Anesthesia and Research Centre, Centre Hospitalier de l'University de Montreal, Hospital Notre-Dame, QC, Canada
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Rohan D, Buggy DJ, Crowley S, Ling FKH, Gallagher H, Regan C, Moriarty DC. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly. Can J Anaesth 2005; 52:137-42. [PMID: 15684252 DOI: 10.1007/bf03027718] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ss protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery. METHODS Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100beta protein and Neuron-Specific Enolase levels were also documented. RESULTS POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100beta protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values. CONCLUSION The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100beta protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.
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Affiliation(s)
- Denise Rohan
- Department of Anesthesia, Critical Care and Pain Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
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Lozano S, Mossad E. Cerebral function monitors during pediatric cardiac surgery: can they make a difference? J Cardiothorac Vasc Anesth 2005; 18:645-56. [PMID: 15578481 DOI: 10.1053/j.jvca.2004.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sara Lozano
- Department of Cardiothoracic Anesthesia, Division of Anesthesiology & Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kanbak M, Saricaoglu F, Avci A, Ocal T, Koray Z, Aypar U. Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels. Can J Anaesth 2004; 51:712-7. [PMID: 15310641 DOI: 10.1007/bf03018431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100beta protein and neuropsychological tests after coronary artery bypass grafting (CABG). METHODS Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group P. Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100beta protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24(th) hr postoperatively (T5). RESULTS Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P, S-100beta protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05). CONCLUSIONS Despite reports about the neuroprotective effects of propofol, S-100beta protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.
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Affiliation(s)
- Meral Kanbak
- Department of Anesthesiology and Reanimation, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey.
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Scaccianoce S, Del Bianco P, Pannitteri G, Passarelli F. Relationship between stress and circulating levels of S100B protein. Brain Res 2004; 1004:208-11. [PMID: 15033438 DOI: 10.1016/j.brainres.2004.01.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2004] [Indexed: 11/29/2022]
Abstract
It has been proposed that S100B can be a marker for several pathological conditions including brain traumas, blood-brain barrier disruption, and ischemia. Because the hypothalamo-pituitary-adrenal axis is activated in these conditions, we investigated the role of glucocorticoids in the effects of stress on serum S100B. Restraint stress increased S100B levels in control and in adrenalectomized but not in corticosterone-injected rats. Adrenalectomy did not alter basal S100B. These results indicate a glucocorticoid-independent relationship between stress and S100B.
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Affiliation(s)
- Sergio Scaccianoce
- Department of Human Physiology and Pharmacology Vittorio Erspamer, University of Rome La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy.
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Ilcol YO, Uncu G, Goren S, Sayan E, Ulus IH. Declines in serum free and bound choline concentrations in humans after three different types of major surgery. Clin Chem Lab Med 2004; 42:1390-5. [PMID: 15576301 DOI: 10.1515/cclm.2004.259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractWe examined the changes in circulating choline status in humans in response to major surgery by measuring serum free and phospholipid-bound choline concentrations before, during and 1–72h after total abdominal hysterectomy, off-pump coronary artery graft surgery or brain tumor surgery. Preoperatively, the mean serum free and phospholipid-bound choline concentrations in patients scheduled for abdominal hysterectomy (n=26), off-pump coronary artery grafting surgery (n=34) or brain tumor surgery (n=24) were 12.3±0.5, 12.1±0.4 and 11.4±0.4μmol/l, and 2495±75, 2590±115 and 2625±80μmol/l, respectively. Serum free choline and phospholipid-bound choline concentrations decreased from these baseline values to 8.8±0.7 (p<0.001), 8.8±0.5 (p<0.001) and 8.2±0.4μmol/l (p<0.001), and 2050±108 (p<0.001), 2166±59 (p<0.001) and 1884±104μmol/l (p<0.001) at 1h after hysterectomy, off-pump bypass graft surgery or brain tumor surgery, respectively. They remained at these low levels for 24h and then gradually increased towards the preoperative values at 48–72h postoperatively. Serum cortisol increased postoperatively in all surgical patients for 24h and its levels were inversely correlated with serum free and bound choline concentrations. These results show that circulating free and bound choline concentrations decrease for 72h after total abdominal hysterectomy, off-pump coronary artery graft surgery or brain tumor surgery in humans.
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Affiliation(s)
- Yesim Ozarda Ilcol
- Department of Biochemistry and Clinical Biochemistry, Uludag University Medical School, Bursa, Turkey
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Dworschak M, Franz M, Czerny M, Gorlitzer M, Blaschek M, Grubhofer G, Haider W. Release of neuron-specific enolase and S100 after implantation of cardioverters/defibrillators. Crit Care Med 2003; 31:2085-9. [PMID: 12973163 DOI: 10.1097/01.ccm.0000079610.88771.62] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Repeated induction of ventricular fibrillation with ensuing alterations in electroencephalogram and jugular venous oxygen saturation is common practice during insertion of transvenous implantable cardioverters/defibrillators. We investigated whether these functional changes are also associated with cerebral injury. DESIGN Prospective study. SETTING University hospital. PATIENTS We studied 45 patients undergoing implantable cardioverter/defibrillator insertion. Eleven patients with cardiac pacemaker implantation, which was performed in the same manner yet without the necessity to induce ventricular fibrillation, served as controls. MEASUREMENTS AND MAIN RESULTS Serum neuron-specific enolase and S100 were determined before, immediately postoperatively, and 2 hrs postoperatively. In a randomly composed subgroup, neuron-specific enolase was also determined 6 and 24 hrs after surgery. Implantable cardioverter/defibrillator patients only showed an increase of both markers postoperatively. Median neuron-specific enolase values climbed from a preoperative 9.9 to 12.3 and 14.4 microg/L at 2 and 24 hrs after surgery, respectively. This increase was associated with the number of shocks and the cumulative time in circulatory arrest. The highest median S100 level (0.075 microg/L) was reached 2 hrs after the procedure. Neuron-specific enolase and S100 were extremely elevated (13.7 and 0.970 microg/L, respectively) in one patient after an extended episode of ventricular fibrillation. Plasma hemoglobin levels were in the normal range in implantable cardioverter/defibrillator patients throughout the observation period. CONCLUSIONS Apparently, even brief successive periods of global cerebral ischemia cause neuronal damage without obvious severe neurologic deficits. However, they may be related to subtle postoperative neurologic or cognitive dysfunctions that a number of implantable cardioverter/defibrillator patients exhibit after implantation.
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Affiliation(s)
- Martin Dworschak
- Division of Cardiothoracic Anesthesia and Intensive Care, University Hospital, Vienna, Austria.
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Reply to letter by Heyer and Connolly. Acta Anaesthesiol Scand 2003. [DOI: 10.1034/j.1399-6576.2003.00178.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rasmussen LS, Sperling B, Abildstrøm HH, Moller JT. Neuron loss after coronary artery bypass detected by SPECT estimation of benzodiazepine receptors. Ann Thorac Surg 2002; 74:1576-80. [PMID: 12440611 DOI: 10.1016/s0003-4975(02)03955-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cerebral dysfunction is common after cardiac surgery and probably related to embolic phenomena, but the etiological mechanisms have not been elucidated. The aim of this study was to assess whether a possible neuron loss could be detected by single photon emission computer tomography (SPECT) estimation of benzodiazepine receptor density. In addition, we correlated the findings with neuropsychological test results. METHODS We included 15 elderly patients undergoing coronary artery bypass surgery. Neuropsychological testing was performed before surgery and postoperatively at discharge from hospital and after 3 months using a neuropsychological test battery. SPECT was performed before surgery and after 3 months using the iomazenil bolus/infusion technique, and the benzodiazepine receptor density was calculated for the frontal, parietal, temporal, and occipital cortex. RESULTS Cognitive dysfunction was found in 46.7% at discharge from hospital and in 6.7% after 3 months. A significant decrease in the estimated density of neurons was found in the frontal cortex, but no significant correlation was found between cognitive dysfunction and SPECT findings. CONCLUSIONS Neuron loss was detectable in the frontal cortex, but the decrease did not correlate with neuropsychological test results.
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Affiliation(s)
- Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark.
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