1
|
Zhang R, Zhang W, Ren Y, Yu J, Li L, Zhang Y. Recent developments in delirium after oral and maxillofacial free-flap reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 126:102045. [PMID: 39244025 DOI: 10.1016/j.jormas.2024.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/28/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
Postoperative delirium (POD), a common complication following surgery and anesthesia, is particularly prone to occur after reconstruction surgery in the oral and maxillofacial region. The occurrence of POD seriously affects the incidence of postoperative complications, the survival of free flaps, the length of hospital stays, and brings great pain to patients and their families, and even increases perioperative mortality. Currently, a large number of studies have reported on the risk factors for POD after oral and maxillofacial free-flap reconstruction. Multiple independent risk factors have been identified, including age, history of excessive alcohol consumption, and perioperative nutritional status. This review summarizes the relevant literature and hopes to provide insights for the prevention of POD in high-risk patients.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Neurosurgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wuxia Zhang
- Clinic Trial Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanming Ren
- Department of Neurosurgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingya Yu
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Li
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China.
| | - Yuekang Zhang
- Department of Neurosurgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
2
|
Association between cholinesterase activity and critical illness brain dysfunction. Crit Care 2022; 26:377. [PMID: 36474266 PMCID: PMC9724294 DOI: 10.1186/s13054-022-04260-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Delirium is a frequent manifestation of acute brain dysfunction and is associated with cognitive impairment. The hypothesized mechanism of brain dysfunction during critical illness is centered on neuroinflammation, regulated in part by the cholinergic system. Point-of-care serum cholinesterase enzyme activity measurements serve as a real-time index of cholinergic activity. We hypothesized that cholinesterase activity during critical illness would be associated with delirium in the intensive care unit (ICU) and cognitive impairment after discharge. METHODS We enrolled adults with respiratory failure and/or shock and measured plasma acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity on days 1, 3, 5, and 7 after enrollment. AChE values were also normalized per gram of hemoglobin (AChE/Hgb). We assessed for coma and delirium twice daily using the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the ICU to evaluate daily mental status (delirium, coma, normal) and days alive without delirium or coma. Cognitive impairment, disability, and health-related quality of life were assessed at up to 6 months post-discharge. We used multivariable regression to determine whether AChE, AChE/Hgb, and BChE activity were associated with outcomes after adjusting for relevant covariates. RESULTS We included 272 critically ill patients who were a median (IQR) age 56 (39-67) years and had a median Sequential Organ Failure Assessment score at enrollment of 8 (5-11). Higher daily AChE levels were associated with increased odds of being delirious versus normal mental status on the same day (Odds Ratio [95% Confidence Interval] 1.64 [1.11, 2.43]; P = 0.045). AChE/Hgb and BChE activity levels were not associated with delirious mental status. Lower enrollment BChE was associated with fewer days alive without delirium or coma (P = 0.048). AChE, AChE/Hgb, and BChE levels were not significantly associated with cognitive impairment, disability, or quality of life after discharge. CONCLUSION Cholinesterase activity during critical illness is associated with delirium but not with outcomes after discharge, findings that may reflect mechanisms of acute brain organ dysfunction. TRIAL REGISTRATION NCT03098472. Registered 31 March 2017.
Collapse
|
3
|
Fricke F, Gebert J, Kopitz J, Plaschke K. Proinflammatory Extracellular Vesicle-Mediated Signaling Contributes to the Induction of Neuroinflammation in Animal Models of Endotoxemia and Peripheral Surgical Stress. Cell Mol Neurobiol 2021; 41:1325-1336. [PMID: 32557202 PMCID: PMC8225539 DOI: 10.1007/s10571-020-00905-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
Peripheral inflammation induced by endotoxemia or surgical stress induces neuroinflammation thereby causing neurological symptoms ranging from sickness behavior to delirium. Thus, proinflammatory signaling must be operative between the periphery and the central nervous system (CNS). In the present study, we tested whether nanometer-sized extracellular vesicles (EVs) that were produced during the peripheral inflammatory process have the capacity to induce neuroinflammation. Conditions of endotoxemia or surgical intervention were simulated in rats by lipopolysaccharide (LPS) injection or partial hepatectomy (HpX). EVs were concentrated from these animals and tested for their proinflammatory action (I) in a microglial cell line and (II) by intracerebroventricular and (III) by intravenous injections into healthy rats. EVs from both conditions induced the secretion of cytokines from the glial cell line. Intracerebroventricular injection of the EVs caused the release of inflammatory cytokines to the cerebrospinal fluid indicating their pro-neuroinflammatory capacity. Finally, proinflammatory EVs were shown to pass the blood-brain barrier and induce neuroinflammation after their intravenous injection. Based on these data, we suggest that EV-associated proinflammatory signaling contributes to the induction of neuroinflammation in endotoxemia and peripheral surgical stress. Preliminary results suggest that peripheral cholinergic signals might be involved in the control of proinflammatory EV-mediated signaling from the periphery to the brain.
Collapse
Affiliation(s)
- F Fricke
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - J Gebert
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - J Kopitz
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - K Plaschke
- Department of Anesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| |
Collapse
|
4
|
Lv XC, Lin Y, Wu QS, Wang L, Hou YT, Dong Y, Chen LW. Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair. J Cardiothorac Surg 2021; 16:146. [PMID: 34044881 PMCID: PMC8161913 DOI: 10.1186/s13019-021-01529-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD. METHODS Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD. RESULTS The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively. CONCLUSIONS Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.
Collapse
Affiliation(s)
- Xiao-Chai Lv
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Yong Lin
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Lei Wang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Yan-Ting Hou
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Yi Dong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China.,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China.,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China.,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou, 350001, Fujian, China. .,Department of Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fujian, China. .,Department of Fujian Provincial Special Reserve Talents Laboratory, Fujian, China. .,Department of Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, Fujian, China.
| |
Collapse
|
5
|
Zhou Y, Wang J, Li X, Li K, Chen L, Zhang Z, Peng M. Neuroprotectin D1 Protects Against Postoperative Delirium-Like Behavior in Aged Mice. Front Aging Neurosci 2020; 12:582674. [PMID: 33250764 PMCID: PMC7674198 DOI: 10.3389/fnagi.2020.582674] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
Postoperative delirium (POD) is the most common postoperative complication affecting elderly patients, yet the underlying mechanism is elusive, and effective therapies are lacking. The neuroinflammation hypothesis for the pathogenesis of POD has recently emerged. Accumulating evidence is supporting the role of specialized proresolving lipid mediators (SPMs) in regulating inflammation. Neuroprotectin D1 (NPD1), a novel docosahexaenoic acid (DHA)-derived lipid mediator, has shown potent immunoresolvent and neuroprotective effects in several disease models associated with inflammation. Here, using a mouse model of POD, we investigated the role of NPD1 in postoperative cognitive impairment by assessing systemic inflammatory changes, the permeability of the blood–brain barrier (BBB), neuroinflammation, and behavior in aged mice at different time points. We report that a single dose of NPD1 prophylaxis decreased the expression of tumor necrosis factor alpha TNF-α and interleukin (IL)-6 and upregulated the expression of IL-10 in peripheral blood, the hippocampus, and the prefrontal cortex. Additionally, NPD1 limited the leakage of the BBB by increasing the expression of tight junction (TJ)-associated proteins such as ZO-1, claudin-5, and occludin. NPD1 also abolished the activation of microglia and astrocytes in the hippocampus and prefrontal cortex, which is associated with improved general and memory function after surgery. In addition, NPD1 treatment modulated the inflammatory cytokine expression profile and improved the expression of the M2 marker CD206 in lipopolysaccharide (LPS)-stimulated macrophages, which may partly explain the beneficial effects of NPD1 on inflammation. Collectively, these findings shed light on the proresolving activities of NPD1 in the pro-inflammatory milieu both in vivo and in vitro and may bring a novel therapeutic approach for POD.
Collapse
Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiayu Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Chen
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mian Peng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
6
|
Alam A, Hana Z, Jin Z, Suen KC, Ma D. Surgery, neuroinflammation and cognitive impairment. EBioMedicine 2018; 37:547-556. [PMID: 30348620 PMCID: PMC6284418 DOI: 10.1016/j.ebiom.2018.10.021] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 12/25/2022] Open
Abstract
Trauma experienced during surgery can contribute to the development of a systemic inflammatory response that can cause multi-organ dysfunction or even failure. Post-surgical neuroinflammation is a documented phenomenon that results in synaptic impairment, neuronal dysfunction and death, and impaired neurogenesis. Various pro-inflammatory cytokines, such as TNFα, maintain a state of chronic neuroinflammation, manifesting as post-operative cognitive dysfunction and post-operative delirium. Furthermore, elderly patients with post-operative cognitive dysfunction or delirium are three times more likely to experience permanent cognitive impairment or dementia. We conducted a narrative review, considering evidence extracted from various databases including Pubmed, MEDLINE and EMBASE, as well as journals and book reference lists. We found that further pre-clinical and well-powered clinical studies are required to delineate the precise pathogenesis of post-operative delirium and cognitive dysfunction. Despite the burden of post-operative neurological sequelae, clinical studies investigating therapeutic agents, such as dexmedetomidine, ibuprofen and statins, have yielded conflicting results. In addition, evidence supporting novel therapeutic avenues, such as nicotinic and HMGB-1 targeting and remote ischaemic pre-conditioning, is limited and necessitates further investigation.
Collapse
Affiliation(s)
- Azeem Alam
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zac Hana
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zhaosheng Jin
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ka Chun Suen
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| |
Collapse
|