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Iqbal M, Zaman M, Ojha N, Gau YTA, Young EI. The known and unknown of post-pump chorea: a case report on robust steroid responsiveness implicating occult neuroinflammation. Front Immunol 2024; 15:1458022. [PMID: 39318628 PMCID: PMC11419990 DOI: 10.3389/fimmu.2024.1458022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024] Open
Abstract
Post-pump chorea (PPC) is characterized by the development of choreiform movements following cardiopulmonary bypass (CPB) surgery. PPC occurs almost exclusively in children, and its pathophysiology remains unclear. Here we present an adult case of PPC after bovine aortic valve replacement (AVR) which exhibited dramatic and reproducible response to steroid, suggesting the presence of occult neuroinflammation. This observation suggests a novel underlying mechanism in certain subgroups of PPC, which is likely a heterogeneous condition to start with. Further research into the pathomechanisms of PPC could offer insights into managing this otherwise symptomatic control-only condition.
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Affiliation(s)
- Muhammad Iqbal
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Muizz Zaman
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Niranjan Ojha
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Yung-Tian A Gau
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, United States
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eufrosina I Young
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, United States
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2
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Zhou W, Zhu B, Weng Y, Chen C, Ni J, Shen W, Lan W, Wang J. The Combination of Presurgical Cortical Gray Matter Volumetry and Cerebral Perfusion Improves the Efficacy of Predicting Postoperative Cognitive Impairment of Elderly Patients. Tomography 2024; 10:1379-1396. [PMID: 39330750 PMCID: PMC11435822 DOI: 10.3390/tomography10090104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/23/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common complication of the central nervous system in elderly surgical patients. Structural MRI and arterial spin labelling (ASL) techniques found that the grey matter volume and cerebral perfusion in some specific brain areas are associated with the occurrence of POCD, but the results are inconsistent, and the predictive accuracy is low. We hypothesised that the combination of cortical grey matter volumetry and cerebral blood flow yield higher accuracy than either of the methods in discriminating the elderly individuals who are susceptible to POCD after abdominal surgery. MATERIALS AND METHODS Participants underwent neuropsychological testing before and after surgery. Postoperative cognitive dysfunction (POCD) was defined as a decrease in cognitive score of at least 20%. ASL-MRI and T1-weighted imaging were performed before surgery. We compared differences in cerebral blood flow (CBF) and cortical grey matter characteristics between POCD and non-POCD patients and generated receiver operating characteristic curves. RESULTS Out of 51 patients, 9 (17%) were diagnosed with POCD. CBF in the inferior frontal gyrus was lower in the POCD group compared to the non-POCD group (p < 0.001), and the volume of cortical grey matter in the anterior cingulate gyrus was higher in the POCD group (p < 0.001). The highest AUC value was 0.973. CONCLUSIONS The combination of cortical grey matter volumetry and cerebral perfusion based on ASL-MRI has improved efficacy in the early warning of POCD to elderly abdominal surgical patients.
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Affiliation(s)
- Weijian Zhou
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
- Health Science Centre, Ningbo University, Ningbo 315211, China
| | - Binbin Zhu
- Department of Anaesthesiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
- Health Science Centre, Ningbo University, Ningbo 315211, China
| | - Yifei Weng
- Department of Radiology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Siming District, Xiamen 361026, China
| | - Chunqu Chen
- Health Science Centre, Ningbo University, Ningbo 315211, China
| | - Jiajing Ni
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
- Health Science Centre, Ningbo University, Ningbo 315211, China
| | - Wenqi Shen
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
- Health Science Centre, Ningbo University, Ningbo 315211, China
| | - Wenting Lan
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
| | - Jianhua Wang
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
- Department of Radiology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Siming District, Xiamen 361026, China
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3
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Moaiyeri Z, Mustafa J, Lamperti M, Lobo FA. Intraoperative use of processed electroencephalogram in a quaternary center: a quality improvement audit. J Clin Monit Comput 2024:10.1007/s10877-024-01189-4. [PMID: 38900394 DOI: 10.1007/s10877-024-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Although intraoperative electroencephalography (EEG) is not consensual among anesthesiologists, growing evidence supports its use to titrate anesthetic drugs, assess the level of arousal/consciousness, and detect ischemic cerebrovascular events; in addition, intraoperative EEG monitoring may decrease the incidence of postoperative neurocognitive disorders. Based on the known and potential benefits of intraoperative EEG monitoring, an educational program dedicated to staff anesthesiologists, residents of Anesthesiology and anesthesia technicians was started at Cleveland Clinic Abu Dhabi in May 2022 and completed in June 2022, aiming to have all patients undergoing general anesthesia with adequate brain monitoring and following international initiatives promoting perioperative brain health. All the surgical cases performed under General Anesthesia at 24 daily locations were prospectively inspected during 15 consecutive working days in March 2023. The use or absence of a processed EEG monitor was registered. Of 379 surgical cases distributed by 24 locations under General Anesthesia, 233 cases (61%) had processed EEG monitoring. The specialty with the highest use of EEG monitoring was Cardiothoracic Surgery, with 100% of cases, followed by interventional Cardiology (90%) and Vascular Surgery (75%). Otorhinolaryngology (29%), Gastrointestinal Endoscopy (25%), and Interventional Pulmonology (20%) were the areas with the lowest use of EEG monitoring. Of note, in the Neuroradiology suite, no processed EEG monitor was used in cases under General Anesthesia. We identified a reasonable use of EEG monitoring during general anesthesia, unfortunately not reaching our target of 100%. The educational and support program previously implemented within the Anesthesiology Institute needs to be continued and improved, including workshops, online discussions, and journal club sessions, to increase the use of EEG monitoring in underused areas.
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Affiliation(s)
- Zahra Moaiyeri
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jumana Mustafa
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Francisco A Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
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4
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Sun Q, Wu W. Effect of near-infrared spectroscopy on postoperative delirium in cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1404210. [PMID: 38962088 PMCID: PMC11221214 DOI: 10.3389/fcvm.2024.1404210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Background Postoperative delirium (POD) is a common anesthetic side effect in cardiac surgery. However, the role of oxygen saturation monitoring in reducing postoperative delirium has been controversial. Therefore, this meta-analysis aimed to analyze whether NIRS monitoring during cardiac surgery under cardiopulmonary bypass could reduce the incidence of postoperative delirium. Methods PubMed, Web of Science, Cochrane Library, Embase and China National Knowledge Infrastructure (CNKI) databases were systematically searched using the related keywords for randomized-controlled trials (RCTs) published from their inception to March 16, 2024. This review was conducted by the Preferred Reporting Project and Meta-Analysis Statement (PRISMA) guidelines for systematic review. The primary outcome was postoperative delirium, and the second outcomes included the length of ICU stay, the incidence of kidney-related adverse outcomes, and the incidence of cardiac-related adverse outcomes. Results The incidence of postoperative delirium could be reduced under the guidance of near-infrared spectroscopy monitoring (OR, 0.657; 95% CI, 0.447-0.965; P = 0.032; I2 = 0%). However, there were no significant differences in the length of ICU stay (SMD, 0.005 days; 95% CI, -0.135-0.146; P = 0.940; I2 = 39.3%), the incidence of kidney-related adverse outcomes (OR, 0.761; 95% CI, 0.386-1.500; P = 0.430; I2 = 0%), and the incidence of the cardiac-related adverse outcomes (OR, 1.165; 95% CI, 0.556-2.442; P = 0.686; I2 = 0%) between the two groups. Conclusion Near-infrared spectroscopy monitoring in cardiac surgery with cardiopulmonary bypass helps reduce postoperative delirium in patients. Systematic Review Registration PROSPERO, identifier, CRD42023482675.
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Affiliation(s)
| | - Weiguo Wu
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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5
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Zhang CY, Yang YS, Pei MQ, Chen XL, Chen WC, He HF. The Association of Cerebral Oxygen Desaturation with Postoperative Cognitive Dysfunction in Older Patients: A Review. Clin Interv Aging 2024; 19:1067-1078. [PMID: 38911674 PMCID: PMC11192837 DOI: 10.2147/cia.s462471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a neurological complication associated with surgery and anesthesia that is commonly observed in older patients, and it can significantly affect patient prognosis and survival. Therefore, predicting and preventing POCD is important. Regional cerebral oxygen saturation (rSO2) reflects cerebral perfusion and oxygenation, and decreased intraoperative cerebral oxygen saturation has been reported to increase the risk of POCD. In this review, we elucidated the important relationship between the decline in rSO2 and risk of POCD in older patients. We also emphasized the importance of monitoring rSO2 during surgery to predict and prevent adverse perioperative cognitive outcomes. The findings reveal that incorporating intraoperative rSO2 monitoring into clinical practice has potential benefits, such as protecting cognitive function, reducing perioperative adverse outcomes, and ultimately improving the overall quality of life of older adults.
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Affiliation(s)
- Chun-Yan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
| | - Yu-Shen Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
| | - Meng-Qin Pei
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
| | - Xin-Li Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
| | - Wei-can Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
| | - He-Fan He
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China
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6
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Wen P, Luo P, Yang M, Huang J, Long Y, Liu L, Xu P. Knowledge mapping and research trends on perioperative neurocognitive disorder from 1990 to 2022: a bibliometric analysis. Ann Med Surg (Lond) 2024; 86:2058-2066. [PMID: 38576958 PMCID: PMC10990356 DOI: 10.1097/ms9.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Perioperative neurocognitive disorder (PND) has attracted consistently increasing attention worldwide. However, there are few bibliometric studies that systematically evaluate this field. This study aimed to visualize the knowledge structure and research trends in PND through bibliometrics to help understand the future development of basic and clinical research. Methods Literature related to PND in Web of Science and PubMed from 1990 to 2022 were collected through keywords retrospectively. Additionally, the source information, citation information, etc. of these publications were extracted. Finally, bibliometric analysis was performed by visualization software and statistical software. Results There were 2837 articles and reviews in total. An exponential rise in PND-related publications was observed. China had the most publication, followed by the US and Germany. The institution with the most output and citations was Harvard University (149 papers, 8966 citations). The most prominent author was Marcantonio Edward R with 66 publications and 5721 citations. The journal with the highest productivity for PND research was Frontiers in Aging Neuroscience followed by Anesthesia and Analgesia. Keywords were identified as six topics, including postoperative delirium, postoperative neurocognitive disorder, cardiac surgery, anaesthesia, orthopedic surgery, and dementia. According to keyword analysis, the most recent popular keywords in PND research were prevention, older patients, emergence delirium, orthopedic surgery, and dexmedetomidine. Conclusions Publications on PND are increasing at an alarming rate from 1990 to 2022. Current research and future trends will concentrate on the prevention and treatment of PND, as well as PND associated with orthopedic surgery in older adults.
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Affiliation(s)
| | - Pan Luo
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Jingyuan Huang
- Anesthesiology, Honghui Hospital, Xi’an Jiaotong University, Shaanxi
| | - Yunfei Long
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Liu
- Departments of Joint Surgery
| | - Peng Xu
- Departments of Joint Surgery
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7
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Verdonk F, Cambriel A, Hedou J, Ganio E, Bellan G, Gaudilliere D, Einhaus J, Sabayev M, Stelzer IA, Feyaerts D, Bonham AT, Ando K, Choisy B, Drover D, Heifets B, Chretien F, Aghaeepour N, Angst MS, Molliex S, Sharshar T, Gaillard R, Gaudilliere B. An immune signature of postoperative cognitive decline in elderly patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.02.582845. [PMID: 38496400 PMCID: PMC10942349 DOI: 10.1101/2024.03.02.582845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Postoperative cognitive decline (POCD) is the predominant complication affecting elderly patients following major surgery, yet its prediction and prevention remain challenging. Understanding biological processes underlying the pathogenesis of POCD is essential for identifying mechanistic biomarkers to advance diagnostics and therapeutics. This longitudinal study involving 26 elderly patients undergoing orthopedic surgery aimed to characterize the impact of peripheral immune cell responses to surgical trauma on POCD. Trajectory analyses of single-cell mass cytometry data highlighted early JAK/STAT signaling exacerbation and diminished MyD88 signaling post-surgery in patients who developed POCD. Further analyses integrating single-cell and plasma proteomic data collected before surgery with clinical variables yielded a sparse predictive model that accurately identified patients who would develop POCD (AUC = 0.80). The resulting POCD immune signature included one plasma protein and ten immune cell features, offering a concise list of biomarker candidates for developing point-of-care prognostic tests to personalize perioperative management of at-risk patients. The code and the data are documented and available at https://github.com/gregbellan/POCD . Teaser Modeling immune cell responses and plasma proteomic data predicts postoperative cognitive decline.
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8
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Zhang X, Wang X, Xu Z, Sun F, Jia Y, Tian Y. Siglec-E Ligand Downregulation on Hippocampus Neurons Induced Inflammation in Sevoflurane-Associated Perioperative Neurocognitive Disorders in Aged Mice. Inflammation 2024; 47:30-44. [PMID: 37603227 DOI: 10.1007/s10753-023-01888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Activated microglia-induced inflammation in the hippocampus plays an important role in perioperative neurocognitive disorders. Previous studies have shown that sialic acid-binding immunoglobulin-like lectin 3 (hSiglec-3, ortholog of mouse Siglec-E) engagement in microglia and its glycan ligands on neurons contributes to inflammatory homeostasis through an endogenous negative regulation pathway. This study aimed to explore whether the glycan ligand alteration on neurons plays a role in sevoflurane-induced perioperative neurocognitive disorders. This study's data has shown that a slight Siglec-E ligands' expression decrease does not induce inflammation homeostasis disruption. We also demonstrated that the ligand level on neurons was decreased with age, and the reduced Siglec-E ligand expression on neurons caused via sevoflurane was induced by neuraminidase 1. Furthermore, this study has shown that the Siglec-E ligand expression decline caused by age and sevoflurane treatment could decrease the ligands' level, thus leading to inflammatory homeostasis disruption. This research provided a novel mechanism for perioperative neurocognitive disorder susceptibility in the elderly.
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Affiliation(s)
- Xiaoli Zhang
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Xueting Wang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China
| | - Ziyang Xu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China
| | - Fengwei Sun
- Department of Anesthesiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China
| | - Yi Jia
- Institute of Materia Medica and Department of Pharmaceutics, College of Pharmacy, Army Medical University, Chongqing, 400038, China
| | - Yue Tian
- Department of Anesthesiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China.
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9
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Zhu M, Long S, Tao Y, Zhang Z, Zhou Z, Wang X, Chen W. The P38MAPK/ATF2 signaling pathway is involved in PND in mice. Exp Brain Res 2024; 242:109-121. [PMID: 37973625 PMCID: PMC10786957 DOI: 10.1007/s00221-023-06730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
Accumulating evidence indicates that microglia-mediated neuroinflammation in the hippocampus contributes to the development of perioperative neurocognitive disorder (PND). P38MAPK, a point of convergence for different signaling processes involved in inflammation, can be activated by various stresses. This study aims to investigate the role of the P38MAPK/ATF2 signaling pathway in the development of PND in mice. Aged C57BL/6 mice were subjected to tibial fracture surgery under isoflurane anesthesia to establish a PND animal model. The open field test was used to evaluate the locomotor activity of the mice. Neurocognitive function was assessed with the Morris water maze (MWM) and fear conditioning test (FCT) on postoperative days 1, 3 and 7. The mice exhibited cognitive impairment accompanied by increased expression of proinflammatory factors (IL-1β, TNF-α), proapoptotic molecules (caspase-3, bax) and microglial activation in the hippocampus 1, 3 and 7 days after surgery. Treatment with SB239063 (a P38MAPK inhibitor) decreased the expression of proinflammatory factors, proapoptotic molecules and Iba-1 in the CA1 region of the hippocampus. The number of surviving neurons was significantly increased. Inhibition of the P38MAPK/ATF2 signaling pathway attenuates hippocampal neuroinflammation and neuronal apoptosis in aged mice with PND, thus improving the perioperative cognitive function of the mice.
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Affiliation(s)
- Mengjiao Zhu
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology, Nanjing Road, Wuhan, 430030, Hubei Province, China
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei Province, China
| | - Si Long
- Department of Anesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, Guangdong Province, China
| | - Yizhi Tao
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei Province, China
| | - Zhifa Zhang
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei Province, China
| | - Zhiqiang Zhou
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei Province, China
| | - Xueren Wang
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei Province, China.
| | - Wei Chen
- Department of Integrated Traditional Chinese and Western Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei Province, China.
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10
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Oberman K, van Leeuwen BL, Nabben M, Villafranca JE, Schoemaker RG. J147 affects cognition and anxiety after surgery in Zucker rats. Physiol Behav 2024; 273:114413. [PMID: 37989448 DOI: 10.1016/j.physbeh.2023.114413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/15/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
Vulnerable patients are at risk for neuroinflammation-mediated post-operative complications, including depression (POD) and cognitive dysfunction (POCD). Zucker rats, expressing multiple risk factors for post-operative complications in humans, may provide a clinically relevant model to study pathophysiology and explore potential interventions. J147, a newly developed anti-dementia drug, was shown to prevent POCD in young healthy rats, and improved early post-surgical recovery in Zucker rats. Aim of the present study was to investigate POCD and the therapeutic potential of J147 in male Zucker rats. Risk factors in the Zucker rat strain were evaluated by comparison with lean littermates. Zucker rats were subjected to major abdominal surgery. Acute J147 treatment was provided by a single iv injection (10 mg/kg) at the start of surgery, while chronic J147 treatment was provided in the food (aimed at 30 mg/kg/day), starting one week before surgery and up to end of protocol. Effects on behavior were assessed, and plasma, urine and brain tissue were collected and processed for immunohistochemistry and molecular analyses. Indeed, Zucker rats displayed increased risk factors for POCD, including obesity, high plasma triglycerides, low grade systemic inflammation, impaired spatial learning and decreased neurogenesis. Surgery in Zucker rats reduced exploration and increased anxiety in the Open Field test, impaired short-term spatial memory, induced a shift in circadian rhythm and increased plasma neutrophil gelatinase-associated lipocalin (NGAL), microglia activity in the CA1 and blood brain barrier leakage. Chronic, but not acute J147 treatment reduced anxiety in the Open Field test and protected against the spatial memory decline. Moreover, chronic J147 increased glucose sensitivity. Acute J147 treatment improved long-term spatial memory and reversed the circadian rhythm shift. No anti-inflammatory effects were seen for J147. Although Zucker rats displayed risk factors, surgery did not induce extensive POCD. However, increased anxiety may indicate POD. Treatment with J147 showed positive effects on behavioral and metabolic parameters, but did not affect (neuro)inflammation. The mixed effect of acute and chronic treatment may suggest a combination for optimal treatment.
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Affiliation(s)
- K Oberman
- Department of Molecular Neurobiology, GELIFES, University of Groningen, the Netherlands.
| | - B L van Leeuwen
- Department of Surgery, University Medical Center Groningen, the Netherlands
| | - M Nabben
- Departments of Genetics & Cell Biology and Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J E Villafranca
- Abrexa Pharmaceuticals Inc., San Diego, United States of America
| | - R G Schoemaker
- Department of Molecular Neurobiology, GELIFES, University of Groningen, the Netherlands; University Medical Center Groningen, the Netherlands
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11
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Jufar AH, May CN, Booth LC, Evans RG, Cochrane AD, Marino B, Birchall I, Hood SG, McCall PR, Sanders RD, Yao ST, Ortega-Bernal V, Skene A, Bellomo R, Miles LF, Lankadeva YR. Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial. Anaesthesia 2023; 78:1481-1492. [PMID: 37880924 DOI: 10.1111/anae.16152] [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] [Accepted: 09/11/2023] [Indexed: 10/27/2023]
Abstract
Cardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra-operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α2 -agonist, dexmedetomidine. We tested the effects of dexmedetomidine on renal and cerebral microcirculatory tissue perfusion, oxygenation and histology in a clinically relevant ovine model. Sixteen sheep were studied while conscious, after induction of anaesthesia and during 2 h of cardiopulmonary bypass. Eight sheep were allocated randomly to receive an intravenous infusion of dexmedetomidine (0.4-0.8 μg.kg-1 .h-1 ) from induction of anaesthesia to the end of cardiopulmonary bypass, and eight to receive an equivalent volume of matched placebo (0.9% sodium chloride). Commencement of cardiopulmonary bypass decreased renal medullary tissue oxygenation in the placebo group (mean (95%CI) 5.96 (4.24-7.23) to 1.56 (0.84-2.09) kPa, p = 0.001), with similar hypoxic levels observed in the dexmedetomidine group (6.33 (5.33-7.07) to 1.51 (0.33-2.39) kPa, p = 0.002). While no differences in kidney function (i.e. reduced creatinine clearance) were evident, a greater incidence of histological renal tubular injury was observed in sheep receiving dexmedetomidine (7/8 sheep) compared with placebo (2/8 sheep), p = 0.041. Graded on a semi-quantitative scale (0-3), median (IQR [range]) severity of histological renal tubular injury was higher in the dexmedetomidine group compared with placebo (1.5 (1-2 [0-3]) vs. 0 (0-0.3 [0-1]) respectively, p = 0.013). There was no difference in cerebral tissue microglial activation (neuroinflammation) between the groups. Dexmedetomidine did not reduce renal medullary hypoxia or cerebral neuroinflammation in sheep undergoing cardiopulmonary bypass.
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Affiliation(s)
- A H Jufar
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - C N May
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - L C Booth
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - R G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - A D Cochrane
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - B Marino
- Cell Saving and Perfusion Resources, Melbourne, Australia
| | - I Birchall
- Neurohistology Laboratory, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - S G Hood
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - P R McCall
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - R D Sanders
- Central Clinical School and NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - S T Yao
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - V Ortega-Bernal
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - A Skene
- Department of Anatomical Pathology, Austin Health, Melbourne, Australia
| | - R Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - L F Miles
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Y R Lankadeva
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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12
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Sadeghirad B, Dodsworth BT, Schmutz Gelsomino N, Goettel N, Spence J, Buchan TA, Crandon HN, Baneshi MR, Pol RA, Brattinga B, Park UJ, Terashima M, Banning LBD, Van Leeuwen BL, Neerland BE, Chuan A, Martinez FT, Van Vugt JLA, Rampersaud YR, Hatakeyama S, Di Stasio E, Milisen K, Van Grootven B, van der Laan L, Thomson Mangnall L, Goodlin SJ, Lungeanu D, Denhaerynck K, Dhakharia V, Sampson EL, Zywiel MG, Falco L, Nguyen ALV, Moss SJ, Krewulak KD, Jaworska N, Plotnikoff K, Kotteduwa-Jayawarden S, Sandarage R, Busse JW, Mbuagbaw L. Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis. JAMA Netw Open 2023; 6:e2337239. [PMID: 37819663 PMCID: PMC10568362 DOI: 10.1001/jamanetworkopen.2023.37239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed. Objective To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery. Data Sources MEDLINE, EMBASE, and CINAHL from inception to May 2020. Study Selection Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020. Data Extraction and Synthesis Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data. Main Outcomes and Measures The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD. Results A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for >85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index <18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for >10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72). Conclusions and Relevance In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.
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Affiliation(s)
- Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | | | | | - Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica Spence
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Tayler A. Buchan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Holly N. Crandon
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | - Mohammad R. Baneshi
- The University of Queensland, Australian Women and Girls’ Health Research Centre, School of Public Health, Herston Road, Herston, Queensland, Australia
| | - Robert A. Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Baukje Brattinga
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ui Jun Park
- Transplant & Vascular Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, South Korea
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi-Cho, Shizuoka, Japan
| | - Louise B. D. Banning
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara L. Van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bjørn E. Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Alwin Chuan
- South West Sydney Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
- Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Jeroen L. A. Van Vugt
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Y. Raja Rampersaud
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki Graduate School of Medicine, Hirosaki, Japan
| | - Enrico Di Stasio
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di scienze laboratoristiche ed infettivologiche, UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Institute of Nursing Science, Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | | | - Sarah J. Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Services Center and Oregon Health & Science University, Portland, Oregon
| | - Diana Lungeanu
- Department of Functional Sciences, Centre for Modelling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Kris Denhaerynck
- Institute of Nursing Science, Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Vibhawari Dhakharia
- Department of Gynaecological Oncology, Health Care Global Enterprises Ltd, Bangalore, India
| | - Elizabeth L. Sampson
- Division of Psychiatry, University College London, London, UK
- Department of Psychological Medicine, East London NHS Foundation Trust, Royal London Hospital, London, UK
| | - Michael G. Zywiel
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Lisa Falco
- Zühlke Engineering AG, Schlieren, Switzerland
| | - Anna-Lisa V. Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephana J. Moss
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karla D. Krewulak
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalia Jaworska
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Plotnikoff
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ryan Sandarage
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason W. Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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13
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Hou YR, Xu CY, An MZ, Li ZP, Ni HD, Chen T, Zhou QH. Effect of Dexmedetomidine on Postoperative Plasma Neurofilament Light Chain in Elderly Patients Undergoing Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial. Clin Interv Aging 2023; 18:1565-1576. [PMID: 37727450 PMCID: PMC10506605 DOI: 10.2147/cia.s422560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose Dexmedetomidine exerts a neuroprotective effect, however, the mechanism underlying this effect remains unclear. This study aimed to explore whether dexmedetomidine can reduce the increase in neurofilament light chain (NfL) protein concentration to play a neuroprotective role during thoracoscopic surgery. Patients and Methods Patients aged ≥60 years undergoing general anesthesia for thoracoscopic surgery were randomly assigned to receive dexmedetomidine (group D) or not receive dexmedetomidine (group C). Patients in group D received a loading dose of dexmedetomidine 0.5 µg/kg before anesthesia induction and a continuous infusion at 0.5 μg·kg-1·h-1 until the end of the surgery. Dexmedetomidine was not administered in group C. The primary outcome was the NfL concentration on postoperative day 1. The concentrations of procalcitonin (PCT), serum amyloid A (SAA), and high-sensitivity C-reactive protein (hs-CRP) were detected preoperatively and on postoperative day 1. In addition, the numerical rating scale (NRS) and quality of recovery-40 (QoR-40) scores were evaluated. Results A total of 38 patients in group D and 37 in group C were included in the analysis. No differences were observed between the groups in terms of the plasma concentration of NfL preoperatively and on postoperative day 1 (11.17 [8.86, 13.93] vs 13.15 [10.76, 15.56] pg/mL, P > 0.05; 16.70 [12.23, 21.15] vs 19.48 [15.25, 22.85] pg/mL, P > 0.05, respectively). However, the postoperative plasma NfL concentration was significantly higher than the preoperative value in both groups (both P < 0.001). The groups exhibited no differences in PCT, SAA, hs-CRP, NRS, and QoR-40 (all P > 0.05). Conclusion Intraoperative administration of dexmedetomidine at a conventional dose does not appear to significantly reduce the increase in postoperative plasma NfL concentration in elderly patients undergoing thoracoscopic surgery. This finding suggests that the neuroprotective effect of dexmedetomidine at a conventional dose was not obvious during general anesthesia.
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Affiliation(s)
- Yue-ru Hou
- Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
| | - Cheng-yun Xu
- Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
| | - Ming-zi An
- Anesthesia Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
| | - Zhen-ping Li
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
| | - Hua-dong Ni
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
| | - Tao Chen
- Department of Anesthesiology, Tongxiang First People’s Hospital, Tongxiang, Zhejiang, People’s Republic of China
| | - Qing-he Zhou
- Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China
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14
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Mulkey MA, Smith AB, Wion RK, House SL, Wierenga KL. Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery: A Systematic Review. J Cardiovasc Nurs 2023; 38:E165-E177. [PMID: 35953076 PMCID: PMC9899292 DOI: 10.1097/jcn.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery. OBJECTIVE The aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery. METHODS CINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022. RESULTS Nineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment. CONCLUSIONS This review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.
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15
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Deng H, Wu Y, Gao P, Kong D, Pan C, Xu S, Tang D, Jiao Y, Wen D, Yu W. Preoperative Pain Facilitates Postoperative Cognitive Dysfunction via Periaqueductal Gray Matter-Dorsal Raphe Circuit. Neuroscience 2023; 524:209-219. [PMID: 36958595 DOI: 10.1016/j.neuroscience.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
Postoperative cognitive dysfunction (POCD) is a medically induced, rapidly occurring postoperative disease, which is hard to recover and seriously threatens the quality of life, especially for elderly patients, so it is important to identify the risk factors for POCD and apply early intervention to prevent POCD. As we have known, pain can impair cognition, and many surgery patients experience different preoperative pain, but it is still unknown whether these patients are vulnerable for POCD. Here we found that chronic pain (7 days, but not 1 day acute pain) induced by Complete Freund's Adjuvant (CFA) injected in the hind paw of rats could easily induce spatial cognition and memory impairment after being exposed to sevoflurane anesthesia. Next, for the mechanisms, we focused on the Periaqueductal Gray Matter (PAG), a well-known pivotal nucleus in pain process. It was detected the existence of neural projection from ventrolateral PAG (vlPAG) to adjacent nucleus Dorsal Raphe (DR), the origin of serotonergic projection for the whole cerebrum, through virus tracing and patch clamp recordings. The Immunofluorescence staining and western blot results showed that Tryptophan Hydroxylase 2 (TPH2) for serotonin synthesis in the DR was increased significantly in the rats treated with CFA for 7 days and sevoflurane for 3 hours, while chemo-genetic inhibition of the vlPAG-DR projection induced obvious spatial learning and memory impairment. Our study suggests that preoperative chronic pain may facilitate cognitive function impairment after receiving anesthesia through the PAG-DR neural circuit, and preventative analgesia should be a considerable measure to reduce the incidence of POCD.
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Affiliation(s)
- Haoyue Deng
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Yi Wu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Po Gao
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Dexu Kong
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Chao Pan
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Saihong Xu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Dan Tang
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China
| | - Yingfu Jiao
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China.
| | - Daxiang Wen
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China.
| | - Weifeng Yu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, P.O. Box 200127, No. 160 Pujian Road, Shanghai, China; Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, China.
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16
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Iizuka Y, Yoshinaga K, Takahashi K, Oki S, Chiba Y, Sanui M, Kimura N, Yamaguchi A. Association between Plasma Ascorbic Acid Levels and Postoperative Delirium in Older Patients Undergoing Cardiovascular Surgery: A Prospective Observational Study. J Cardiovasc Dev Dis 2023; 10:293. [PMID: 37504549 PMCID: PMC10380566 DOI: 10.3390/jcdd10070293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The incidence of delirium is high in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB). Intraoperative tissue hypoperfusion and re-reperfusion injury, which generate reactive oxygen species (ROS), are suggested to induce delirium. Ascorbic acid is an excellent antioxidant and may reduce organ damage by inhibiting the production of ROS. This prospective observational study aimed to measure pre- and postoperative plasma ascorbic acid levels and examine their association with delirium. METHODS Patients older than 70 years of age scheduled for elective cardiovascular surgery using CPB were enrolled. From September 2020 to December 2021, we enrolled 100 patients, and the data of 98 patients were analyzed. RESULTS In total, 31 patients developed delirium, while 67 did not. Preoperative plasma ascorbic acid levels did not differ between the non-delirium and delirium groups (6.0 ± 2.2 vs. 5.5 ± 2.4 µg/mL, p = 0.3). Postoperative plasma ascorbic acid levels were significantly different between the groups (2.8 [2.3-3.5] vs. 2.3 [1.6-3.3] µg/mL, p = 0.037). CONCLUSIONS In patients who undergo cardiovascular surgery with CPB, lower postoperative plasma ascorbic acid levels may be associated with the development of delirium.
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Affiliation(s)
- Yusuke Iizuka
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Koichi Yoshinaga
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Kyosuke Takahashi
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Sayaka Oki
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Yoshihiko Chiba
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
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17
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Dodsworth BT, Reeve K, Falco L, Hueting T, Sadeghirad B, Mbuagbaw L, Goettel N, Schmutz Gelsomino N. Development and validation of an international preoperative risk assessment model for postoperative delirium. Age Ageing 2023; 52:7192246. [PMID: 37290122 DOI: 10.1093/ageing/afad086] [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: 08/01/2022] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent complication in older adults, characterised by disturbances in attention, awareness and cognition, and associated with prolonged hospitalisation, poor functional recovery, cognitive decline, long-term dementia and increased mortality. Early identification of patients at risk of POD can considerably aid prevention. METHODS We have developed a preoperative POD risk prediction algorithm using data from eight studies identified during a systematic review and providing individual-level data. Ten-fold cross-validation was used for predictor selection and internal validation of the final penalised logistic regression model. The external validation used data from university hospitals in Switzerland and Germany. RESULTS Development included 2,250 surgical (excluding cardiac and intracranial) patients 60 years of age or older, 444 of whom developed POD. The final model included age, body mass index, American Society of Anaesthesiologists (ASA) score, history of delirium, cognitive impairment, medications, optional C-reactive protein (CRP), surgical risk and whether the operation is a laparotomy/thoracotomy. At internal validation, the algorithm had an AUC of 0.80 (95% CI: 0.77-0.82) with CRP and 0.79 (95% CI: 0.77-0.82) without CRP. The external validation consisted of 359 patients, 87 of whom developed POD. The external validation yielded an AUC of 0.74 (95% CI: 0.68-0.80). CONCLUSIONS The algorithm is named PIPRA (Pre-Interventional Preventive Risk Assessment), has European conformity (ce) certification, is available at http://pipra.ch/ and is accepted for clinical use. It can be used to optimise patient care and prioritise interventions for vulnerable patients and presents an effective way to implement POD prevention strategies in clinical practice.
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Affiliation(s)
| | - Kelly Reeve
- Institute of Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur 8400, Switzerland
| | - Lisa Falco
- Zühlke Engineering AG, Zürcherstrasse 39J, Schlieren 8952, Switzerland
| | - Tom Hueting
- Evidencio, Irenesingel 19, Haaksbergen 7481 GJ, Netherlands
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON L8S 4L8, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé 12117, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7600, South Africa
| | - Nicolai Goettel
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL 32610, USA
- Department of Clinical Research, University of Basel, Basel 4031, Switzerland
| | - Nayeli Schmutz Gelsomino
- PIPRA AG, Zurich 8005, Switzerland
- Department of Anaesthesia, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
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18
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Chen S, Zhang H, Zhang Y. Effect of transverse thoracic muscle plane block on postoperative cognitive dysfunction after open cardiac surgery: A randomized clinical trial. J Cell Mol Med 2023; 27:976-981. [PMID: 36876723 PMCID: PMC10064032 DOI: 10.1111/jcmm.17710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023] Open
Abstract
The transversus thoracis muscle plane (TTMP) block provides effective analgesia in cardiac surgery patients. The aim of this study was to assess whether bilateral TTMP blocks can reduce the incidence of postoperative cognitive dysfunction (POCD) in patients undergoing cardiac valve replacement. A group of 103 patients were randomly divided into the TTM group (n = 52) and the PLA (placebo) group (n = 51). The primary endpoint was the incidence of POCD at 1 week after surgery. Secondary outcome measures included a reduction of intraoperative mean arterial pressure (MAP) >20% from baseline, intraoperative and postoperative sufentanil consumption, length of stay in the ICU, incidence of postoperative nausea and vomiting (PONV), time to first faeces, postoperative pain at 24 h after surgery, time to extubation and the length of hospital stay. Interleukin (IL)-6, TNF-α, S-100β, insulin, glucose and insulin resistance were measured at before induction of anaesthesia, 1, 3and 7 days after surgery. The MoCA scores were significantly lower and the incidence of POCD decreased significantly in TTM group compared with PLA group at 7 days after surgery. Perioperative sufentanil consumption, the incidence of PONV and intraoperative MAP reduction >20% from baseline, length of stay in the ICU, postoperative pain at 24 h after surgery, time to extubation and the length of hospital stay were significantly decreased in the TTM group. Postoperatively, IL-6, TNF-α, S-100β, HOMA-IR, insulin, glucose levels increased and the TTM group had a lower degree than the PLA group at 1, 3 and 7 days after surgery. In summary, bilateral TTMP blocks could improve postoperative cognitive function in patients undergoing cardiac valve replacement.
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Affiliation(s)
- Shibiao Chen
- Department of AnesthesiologyFirst Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Hua Zhang
- Department of AnesthesiologyNanchang Hongdu Hospital of TCMNanchangChina
| | - Yang Zhang
- Department of AnesthesiologyFirst Affiliated Hospital of Nanchang UniversityNanchangChina
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Hu GW, Xu GH, Lang HL, Zhao YZ, Xiao RJ, Sun J, Chen Y. Small extracellular vesicles secreted by induced pluripotent stem cell-derived mesenchymal stem cells improve postoperative cognitive dysfunction in mice with diabetes. Neural Regen Res 2023; 18:609-617. [DOI: 10.4103/1673-5374.350205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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20
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Nurcahyo WI, Hadisaputro S, Muttaqin Z, Boom CE, Manapa CH, Pramadika T, Tugasworo D. Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG. Vasc Health Risk Manag 2022; 18:915-925. [PMID: 36605932 PMCID: PMC9809160 DOI: 10.2147/vhrm.s386791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/16/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery. Methods This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software. Results The mean age of patients in both groups was 60 years and was dominated by males (>85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs -1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%. Conclusion POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.
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Affiliation(s)
- Widya Istanto Nurcahyo
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia,Correspondence: Widya Istanto Nurcahyo, Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, 50725, Indonesia, Fax +62 2476928010, Email ;
| | - Suharyo Hadisaputro
- Postgraduate Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Zainal Muttaqin
- Neurosurgery Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, Indonesia
| | - Cindy Elfira Boom
- Anaesthesiology Department and Intensive Therapy, National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia
| | - Chandra Hermawan Manapa
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Taufan Pramadika
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Dodik Tugasworo
- Neurology Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, Indonesia
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Li S, Jiang H, Liu W, Yin Y, Yin C, Chen H, Du Y, Zhao Q, Zhang Y, Li C. Transcutaneous electrical acupoint stimulation for the prevention of perioperative neurocognitive disorders in geriatric patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e32329. [PMID: 36550918 PMCID: PMC9771360 DOI: 10.1097/md.0000000000032329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate whether transcutaneous electrical acupoint stimulation (TEAS) decreases rates of perioperative neurocognitive disorders (PND) when used as an adjuvant method during perioperative period in geriatric patients since the new definition was released in 2018. METHODS Six databases [Chinese National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, WanFang Database, PubMed, EMBASE, and Cochrane Library] were systematically searched. Data analysis was performed using RevMan 5.4.1 software (Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020). Risk ratios (RR) with 95% confidence interval were calculated using a random effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS 13 randomized clinical trials (999 patients) in total were included. TEAS had positive effects on preventing the incidence of PND (RR: 0.43; 0.31, 0.61; P < .001; low certainty) [postoperative delirium within 7 days (RR: 0.39; 0.26, 0.59; P < .001), delayed neurocognitive recovery within 3 months (RR: 0.51; 0.33, 0.78; P = .002)]. TEAS could also improve the scores of the confusion assessment method (CAM) (Mean difference: -1.30; -2.14, -0.46; P = .003; low certainty). Limited evidence suggested that TEAS could reduce the serum levels of biochemical indicator (S100β) (SMD = -1.08, -1.67, -0.49, P < .001; I2 = 83%; very low certainty) as well as anesthetic requirements (remifentanil) (SMD: -1.58; -2.54, -0.63; P = .001; I2 = 87%; very low certainty). Subgroup analysis indicated that different protocols of TEAS had significant pooled benefits (TEAS used only in surgery and in combination with postoperative intervention) (RR: 0.45; 0.31, 0.63; P < .001). Acupoint combination (LI4 and PC6) in the TEAS group had more significantly advantages (RR: 0.34; 0.17, 0.67; P = .002). TEAS group had a lower incidence of PND in different surgery type (orthopedic surgery and abdominal surgery) (RR: 0.43; 0.30, 0.60; P < .001), as well as with different anesthetic modality (intravenous anesthesia and intravenous and inhalational combined anesthesia) (RR: 0.38; 0.23, 0.61; P < .001). CONCLUSION In terms of clinical effectiveness, TEAS appeared to be beneficial for prophylaxis of PND during a relatively recent period, noting the limitations of the current evidence.
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Affiliation(s)
- Shuying Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hailun Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wei Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yu Yin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chunsheng Yin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hao Chen
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- * Correspondence: Yuzheng Du, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China (e-mail: )
| | - Qi Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yi Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chen Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Guran E, Hu J, Wefel JS, Chung C, Cata JP. Perioperative considerations in patients with chemotherapy-induced cognitive impairment: a narrative review. Br J Anaesth 2022; 129:909-922. [PMID: 36270848 DOI: 10.1016/j.bja.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Abstract
Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
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Affiliation(s)
- Ekin Guran
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA; Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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23
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Fan D, Chen X, Zhou H, Hu N, Chen C, Yao Y, Bai Y, Feng J, Jia J, Wang X. Plasma microRNA-221-3p as a biomarker for POCD after non-cardiac surgery. PLoS One 2022; 17:e0275917. [PMID: 36219614 PMCID: PMC9553040 DOI: 10.1371/journal.pone.0275917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Our previous study showed that the plasma microRNA-221-3p level could serve as a biomarker for major depression or mood. This study aimed to further investigate the role of plasma microRNA-221-3p level in postoperative cognitive dysfunction (POCD). Patients undergoing non-cardiac surgery were randomly assigned according to the inclusion and exclusion criteria. POCD was diagnosed by the Z score method. The relative level of plasma microRNA-221-3p was decided by quantitative real-time polymerase chain reaction. Multiple logistic regression analysis and receiver operating characteristic(ROC) curves were used for the analysis of plasma microRNA-221-3p prediction performance for POCD. At 7 days post-surgery, the rate of POCD was 34.04%. Patients in the POCD group had a higher preoperative depression score, older age, and longer operation duration than that in the NPOCD group. The relative level of plasma microRNA-221-3p in the POCD group was 1.78 and 2.73 times higher than that in the NPOCD group at 1 day before and 7 days after the surgery, respectively. The relative content of plasma microRNA-221-3p at 7 days after operation was an independent risk factor for POCD. The ROC curves showed that the area under the curve was 0.938 for plasma microRNA-221-3p at postoperative 7 days, and the threshold for POCD detection was 12.33 with a sensitivity and specificity of 81.3% and 96.3%, respectively. Our results indicate that the plasma postoperative microRNA-221-3p levels could be an effective predictor for POCD after non-cardiac surgery.
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Affiliation(s)
- Di Fan
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Xuhui Chen
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Hongli Zhou
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Na Hu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Chengchuan Chen
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Yi Yao
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Yiping Bai
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Jianguo Feng
- Laboratoryof Anesthesiology, Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Jing Jia
- Laboratoryof Anesthesiology, Southwest Medical University, Luzhou, Sichuan Province, P. R. China
| | - Xiaobin Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P. R. China
- * E-mail:
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Devinney MJ, VanDusen KW, Kfouri JM, Avasarala P, Spector AR, Mathew JP, Berger M. The potential link between obstructive sleep apnea and postoperative neurocognitive disorders: current knowledge and possible mechanisms. Can J Anaesth 2022; 69:1272-1287. [PMID: 35982354 PMCID: PMC9924301 DOI: 10.1007/s12630-022-02302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This narrative review examines the current evidence on whether obstructive sleep apnea (OSA) is associated with postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The mechanisms that could predispose OSA patients to these disorders are also explored. SOURCE Relevant literature was identified by searching for pertinent terms in Medline®, Pubmed, ScopusTM, and Google scholar databases. Case reports, abstracts, review articles, original research articles, and meta-analyses were reviewed. The bibliographies of retrieved sources were also searched to identify relevant papers. PRINCIPAL FINDINGS Seven studies have investigated the association between OSA and POD, with mixed results. No studies have examined the potential link between OSA and POCD. If these relationships exist, they could be mediated by several mechanisms, including increased neuroinflammation, blood-brain barrier breakdown, cerebrovascular disease, Alzheimer's disease neuropathology, disrupted cerebral autoregulation, sleep disruption, sympathovagal imbalance, and/or disrupted brain bioenergetics. CONCLUSION There is very limited evidence that OSA plays a role in postoperative neurocognitive disorders because few studies have been conducted in the perioperative setting. Additional perioperative prospective observational cohort studies and randomized controlled trials of sleep apnea treatment are needed. These investigations should also assess potential underlying mechanisms that could predispose patients with OSA to postoperative neurocognitive disorders. This review highlights the need for more research to improve postoperative neurocognitive outcomes for patients with OSA.
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Affiliation(s)
- Michael J Devinney
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
- Duke Hospital South, 3094 MS 01, 40 Medicine Circle, Rm 4324, Orange Zone, Durham, NC, 27710, USA.
| | - Keith W VanDusen
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Jad M Kfouri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Pallavi Avasarala
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Andrew R Spector
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Qeva E, Sollazzo C, Bilotta F. Insulin signaling in the central nervous system, a possible pathophysiological mechanism of anesthesia-induced delayed neurocognitive recovery/postoperative neurocognitive disorder: a narrative review. Expert Rev Neurother 2022; 22:839-847. [PMID: 36332201 DOI: 10.1080/14737175.2022.2144234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Impairment in neurocognitive functions ranges between delayed neurocognitive recovery (DNR) and postoperative neurocognitive disorders (pNCD). Incidence varies from 11% after noncardiac surgery to 60% after cardiac surgery. AREAS COVERED Insulin receptors (IRs) signaling pathway in the central nervous system (CNS) could be a possible pathophysiological mechanism of anesthesia-induced DNR/pNCD and perioperative intranasal insulin administration could be a preventive approach. This hypothesis is supported by the following evidence: effects of IRs-CNS signaling pathway on neuromodulation; higher incidence of DNR/pNCD in patients with insulin resistance; neurotoxicity of IRs signaling pathways after anesthetic exposure; improvement of neurocognitive impairment after insulin exposure. This narrative review was conducted after a literature search of PubMed, EMBASE and SCOPUS online medical data performed in May 2022. EXPERT OPINION Perioperative intranasal insulin is shown to be protective and future studies should address: the role of insulin as a neuromodulator; its integration into neuroprotection approaches; patient populations that might benefit from this approach; a well-defined protocol of intranasal insulin administration in a perioperative background and other disciplines; and possible collateral effects.
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Affiliation(s)
- Ega Qeva
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, 'Policlinico Umberto I' Hospital, 00161 Rome, Italy.,Department of Anesthesia, Intensive Care and Emergency, University of Turin, 'Città Della Salute e Della Scienza' Hospital, 10126 Turin, Italy
| | - Camilla Sollazzo
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, 'Policlinico Umberto I' Hospital, 00161 Rome, Italy
| | - Federico Bilotta
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, 'Policlinico Umberto I' Hospital, 00161 Rome, Italy
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Ji L, Li F. Potential Markers of Neurocognitive Disorders After Cardiac Surgery: A Bibliometric and Visual Analysis. Front Aging Neurosci 2022; 14:868158. [PMID: 35721025 PMCID: PMC9199578 DOI: 10.3389/fnagi.2022.868158] [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: 02/02/2022] [Accepted: 04/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Identifying useful markers is essential for diagnosis and prevention of perioperative neurocognitive disorders (PNDs). Here, we attempt to understand the research basis and status, potential hotspots and trends of predictive markers associated with PNDs after cardiac surgery via bibliometric analysis. Methods A total of 4,609 original research articles and reviews that cited 290 articles between 2001 and 2021 were obtained from the Web of Science Core Collection (WoSCC) as the data source. We used the software CiteSpace to generate and analyze visual networks of bibliographic information, including published years and journals, collaborating institutions, co-cited references, and co-occurring keywords. Results The number of annual and cumulative publications from 2001 to 2021 has been increasing on the whole. The Harvard Medical School was a very prolific and important institution in this field. The journal of Ann Thorac Surg (IF 4.33) had the most publications, while New Engl J Med was the most cited journal. Neuron-specific enolase (NSE), S100b and kynurenic acid (KYNA) were frequently discussed as possible markers of PNDs in many references. Cardiopulmonary bypass (CPB) was a keyword with high frequency (430) and sigma (6.26), and inflammation was the most recent burst keyword. Conclusion Potential markers of PNDs has received growing attention across various disciplines for many years. The research basis mainly focuses on three classic biomarkers of S100b, NSE, and KYNA. The most active frontiers are the inflammation-related biomarkers (e.g., inflammatory cells, cytokines, or mediators) and surgery-related monitoring parameters (e.g., perfusion, oxygen saturation, and the depth of anesthesia).
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Ding Y, Yu J, Cui F, Li J. Comparison of Intravenous and Inhalational Anesthetic on Postoperative Cognitive Outcomes in Elderly Patients Undergoing Cancer Surgery: Systematic Review and Meta-analysis. J Perianesth Nurs 2022; 37:683-690. [PMID: 35618615 DOI: 10.1016/j.jopan.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Previous studies have documented consistent findings on the long-term cognitive effects such as postoperative cognitive dysfunction (POCD), delirium and delayed recovery among elderly undergoing cancer surgery. This review was conducted to compare the effect of intravenous and inhalational anesthetic on the postoperative cognitive outcomes among elderly patients undergoing cancer surgery. DESIGN Systematic review and meta-analysis METHODS: We searched Medline, EMBASE, PubMed Central, ScienceDirect, Google Scholar, and Cochrane library from inception until May 2021. We carried out a meta-analysis with a random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI) depending on the type of outcome. FINDINGS In total, we analyzed 10 studies including 2,333 participants. Half of the studies had high risk of bias. For the cognitive score, the pooled SMD was -0.87 [95% CI: -3.97 to 2.24] indicating no statistically significant difference between inhalational and intravenous anesthetic. For POCD, the pooled RR was 1.24 (95% CI: 0.83-1.84); for postoperative delirium, the pooled RR was 2.26 (95% CI: 0.79-6.44); for delayed neurocognitive recovery, the pooled RR was 1.49 (95% CI: 1.09-2.03). CONCLUSION Inhalational anesthetics did not show a significant difference in postoperative cognitive outcomes, except delayed neurocognitive recovery, compared to intravenous anesthetic following cancer surgery.
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Affiliation(s)
- Yongbo Ding
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jianhong Yu
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Fenghe Cui
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China.
| | - Jie Li
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
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Mignani S, Shi X, Rodrigues J, Tomás H, Majoral JP. Dendrimer nanoplatforms for veterinary medicine applications: A concise overview. Drug Discov Today 2022; 27:1251-1260. [PMID: 34999213 DOI: 10.1016/j.drudis.2022.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 02/08/2023]
Abstract
Within the nanoparticle (NP) space, dendrimers are becoming increasingly important in the field of nanomedicine, not only to treat human diseases, but also in veterinary medicine, which represents a new therapeutic approach. Major applications include using dendrimers to tackle highly contagious foot-and-mouth disease virus (FMDV) and swine fever virus (SFV) in pigs, FMDV in cattle, hypothermic circulatory arrest (HCA) in dogs, rabies, and H9N2 avian influenza virus in chickens. As we review here, intramuscular (im) subcutaneous (sc), intravenous (iv), and intraperitoneal (ip) routes of administration can be used for the successful application of dendrimers in animals.
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Affiliation(s)
- Serge Mignani
- Université Paris Descartes, PRES Sorbonne Paris Cité, CNRS UMR 860, Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologique, 45, Rue des Saints Peres, 75006 Paris, France; CQM - Centro de Química da Madeira, MMRG, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal.
| | - Xiangyang Shi
- CQM - Centro de Química da Madeira, MMRG, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal; College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, PR China.
| | - João Rodrigues
- CQM - Centro de Química da Madeira, MMRG, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal; School of Materials Science and Engineering, Center for Nano Energy Materials, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Helena Tomás
- CQM - Centro de Química da Madeira, MMRG, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal
| | - Jean-Pierre Majoral
- Laboratoire de Chimie de Coordination du CNRS, 205 route de Narbonne, 31077 Toulouse Cedex 4, France; Université Toulouse, 118 Route de Narbonne, 31077 Toulouse Cedex 4, France.
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Wang Y, Machizawa MG, Lisle T, Williams CL, Clarke R, Anzivino M, Kron I, Lee KS. Suppression of Neuroinflammation Attenuates Persistent Cognitive and Neurogenic Deficits in a Rat Model of Cardiopulmonary Bypass. Front Cell Neurosci 2022; 16:780880. [PMID: 35281295 PMCID: PMC8907423 DOI: 10.3389/fncel.2022.780880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023] Open
Abstract
Post-operative cognitive dysfunction (POCD) can be a serious surgical complication, and patients undergoing cardiac procedures are at particular risk for POCD. This study examined the effect of blocking neuroinflammation on behavioral and neurogenic deficits produced in a rat model of cardiopulmonary bypass (CPB). Minocycline, a drug with established anti-inflammatory activity, or saline was administered daily for 30 days post-CPB. Treatment with minocycline reduced the number of activated microglia/macrophages observed in the dentate gyrus of the hippocampus at 6 months post-CPB, consistent with an anti-inflammatory action in this CPB model. Behavioral testing was conducted at 6 months post-CPB utilizing a win-shift task on an 8-arm radial maze. Minocycline-treated animals performed significantly better than saline-treated animals on this task after CPB. In addition, the CPB-induced reduction in adult neurogenesis was attenuated in the minocycline-treated animals. Together, these findings indicate that suppressing neuroinflammation during the early post-surgical phase can limit long-term deficits in both behavioral and neurogenic outcomes after CPB.
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Affiliation(s)
- Yi Wang
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Department of Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, United States
| | - Maro G. Machizawa
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Turner Lisle
- Department of Surgery, Vail Health, Vail, CO, United States
| | - Cedric L. Williams
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Ryon Clarke
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
| | - Matthew Anzivino
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
| | - Irving Kron
- Department of Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Kevin S. Lee
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
- Center for Brain Immunology and Glia (BIG), University of Virginia, Charlottesville, VA, United States
- *Correspondence: Kevin S. Lee,
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Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome. Anesthesiology 2022; 136:843-860. [PMID: 35180291 DOI: 10.1097/aln.0000000000004141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonsteroidal anti-inflammatory drugs are among the most commonly administered drugs in the perioperative period due to their prominent role in pain management. However, they potentially have perioperative consequences due to immune-modulating effects through the inhibition of prostanoid synthesis, thereby affecting the levels of various cytokines. These effects may have a direct impact on the postoperative outcome of patients since the immune system aims to restore homeostasis and plays an indispensable role in regeneration and repair. By affecting the immune response, consequences can be expected on various organ systems. This narrative review aims to highlight these potential immune system-related consequences, which include systemic inflammatory response syndrome, acute respiratory distress syndrome, immediate and persistent postoperative pain, effects on oncological and neurologic outcome, and wound, anastomotic, and bone healing.
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31
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A commentary on "Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: A review article" [Int. J. Surg. 95 (2021) 106163]. Int J Surg 2022; 98:106240. [PMID: 35123012 DOI: 10.1016/j.ijsu.2022.106240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
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32
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A commentary on "Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: A review article" (Int J Surg 2021; 95:106163). Int J Surg 2022; 98:106217. [PMID: 34995809 DOI: 10.1016/j.ijsu.2021.106217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022]
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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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Mignani S, Shi X, Rodrigues J, Tomás H, Majoral JP. Dendrimer nanoplatforms for veterinary medicine applications: A concise overview. Drug Discov Today 2022. [DOI: https://doi.org/10.1016/j.drudis.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ramanan M, Kumar A, Anstey C, Shekar K. Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study. BMJ Open 2021; 11:e049187. [PMID: 34949608 PMCID: PMC8713013 DOI: 10.1136/bmjopen-2021-049187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 12/02/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ). DESIGN Retrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019. SETTING Adult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD). PARTICIPANTS Adult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery. EXPOSURE The primary exposure variable was the calendar year during the which the index surgery was performed. OUTCOME The primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care. RESULTS We analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60-76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD. CONCLUSIONS There was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.
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Affiliation(s)
- Mahesh Ramanan
- ICU, Caboolture Hospital, Caboolture, Queensland, Australia
- Critical Care Division, George Institute for Global Health, Sydney, New South Wales, Australia
- School of Medicine, The University of Queensland School of Medicine, Herston, Queensland, Australia
| | - Aashish Kumar
- ICU, Logan Hospital, Loganholme, Queensland, Australia
| | - Chris Anstey
- School of Medicine, The University of Queensland School of Medicine, Herston, Queensland, Australia
- Sunshine Coast Clinical School, Griffith University School of Medicine, Birtinya, Queensland, Australia
| | - Kiran Shekar
- School of Medicine, The University of Queensland School of Medicine, Herston, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia
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36
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Moving From Mechanisms to Interventions in Research on Cognitive Impairment in Cardiovascular Disease. J Cardiovasc Nurs 2021; 37:5-7. [PMID: 34870946 DOI: 10.1097/jcn.0000000000000877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nurcahyo WI, Arifin A, Primatika AD, Muttaqin Z, Elfira Boom C, Harahap MS, Mochamat M, Nugroho TE, Wicaksono SA. An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement. Vasc Health Risk Manag 2021; 17:713-720. [PMID: 34824534 PMCID: PMC8610747 DOI: 10.2147/vhrm.s334982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is defined as cognitive dysfunction related to inflammation after surgical procedures, which is common following cardiac surgery. Cognitive deficits are thought to result from a systemic inflammatory response. C-reactive protein (CRP) and other proinflammatory cytokines, which are released in response to inflammation, disrupt the blood–brain barrier and neurotransmission, resulting in POCD. This study aimed to determine the correlation between POCD and increased levels of CRP in patients who had undergone heart valve replacement. Methods This study comprised 32 patients with normal cognitive function undergoing heart valve replacement. The CRP levels were measured before surgery and on the second postoperative day, and cognitive function was examined via the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third postoperative day. Data were analyzed using Spearman correlation test. Results Of the 32 patients, 28 (87.5%) experienced POCD. The median level of CRP was 6.6 mg/dL (interquartile range: 4.0, 8.3 g/dL). According to Spearman correlation test, increased levels of CRP were significantly related to POCD following heart valve replacement (p = 0.003, r = 0.501). The receiver operating characteristic curve indicated that the CRP cutoff level was 3.345 mg/dL, and the sensitivity and specificity were 89.3% and 75%, respectively. Conclusion High expression level of CRP was correlated with POCD following heart valve replacement.
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Affiliation(s)
- Widya Istanto Nurcahyo
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Anshoril Arifin
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Aria Dian Primatika
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Cindy Elfira Boom
- Department of Anesthesiology and Intensive Care, Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - M Sofyan Harahap
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Mochamat Mochamat
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Taufik Eko Nugroho
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Satrio Adi Wicaksono
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
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Su C, Ren X, Wang H, Ding X, Guo J. Changing Pain Management Strategy from Opioid-Centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine. Curr Drug Metab 2021; 23:57-65. [PMID: 34791997 DOI: 10.2174/1389200222666211118115347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/21/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. METHODS One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. RESULTS The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). CONCLUSION Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioid-centric towards improved postoperative cognitive dysfunction.
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Affiliation(s)
- Chunhong Su
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaojun Ren
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Hongpei Wang
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaomei Ding
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Jian Guo
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
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The Association between Postoperative Cognitive Dysfunction and Cerebral Oximetry during Geriatric Orthopedic Surgery: A Randomized Controlled Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5733139. [PMID: 34712732 PMCID: PMC8548108 DOI: 10.1155/2021/5733139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022]
Abstract
Background Postoperative cognitive dysfunction (POCD) refers to disorders affecting orientation, attention, perception, consciousness, and judgment that develop after geriatric orthopedic surgery. Cerebral blood oxygen saturation detection is a way to diagnose cerebral oxygen supply during operation. At present, more and more applications are used for early diagnosis of postoperative cognitive function. Therefore, the present study is to analyze the relationship between postoperative cognitive dysfunction and cerebral blood oxygen saturation in elderly orthopedic patients. Methods This study enrolled 90 elderly patients undergoing orthopedic surgery in our hospital. According to the postoperative cognitive dysfunction, they were divided into POCD group (N = 45) and no-POCD (N = 45) group. The cognitive and psychological function and cerebral blood oxygen saturation were analyzed before and 3 months after the operation. Finally, the indicators of cognitive psychological function and the indicators of cerebral blood oxygen saturation are correlated and analyzed. Results Compared with the normal group, patients with cognitive dysfunction at 3 months after surgery time below preoperative rScO2, time below a 10% decrease from preoperative rScO2, CDL preoperative, minimum rScO2 value, and maximum rScO2 value have significant changes. The results of the correlation analysis found that there is also a significant correlation between the postoperative cognitive and psychological function of the patient and the cerebral blood oxygen saturation at 3 weeks after the operation. Conclusion In elderly orthopedic patients, there is a significant relationship between cerebral blood oxygen saturation detection and cognitive function 3 months after surgery.
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40
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Bowden T, Hurt CS, Sanders J, Aitken LM. Predictors of cognitive dysfunction after cardiac surgery: a systematic review. Eur J Cardiovasc Nurs 2021; 21:192-204. [PMID: 34718486 DOI: 10.1093/eurjcn/zvab086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
AIMS Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others.The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardiac surgery. METHODS AND RESULTS Eight bibliographic databases were searched (January 2005 to March 2021) in relation to cardiac surgery and cognition. Studies including adult patients who had undergone open cardiac surgery and using a validated measurement of cognitive function were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors.A total of 2870 papers were identified, of which 36 papers met the inclusion criteria and were included in the review. The majority were prospective observational studies [n = 28 (75.7%)]. In total, 61 independent predictors (45 preoperative and 16 postoperative) were identified as significant in at least one study; advancing age and education level appear important. Age has emerged as the most common predictor of cognitive outcome. CONCLUSION Although a number of predictors of POCD have been identified, they have inconsistently been reported as significantly affecting cognitive outcome. Consistent with previous research, our findings indicate that older patients and those with lower educational levels should be prioritized when developing and trialling interventions to improve cognitive function. These findings are less than surprising if we consider the methodological shortcomings of included studies. It is evident that further high-quality research exploring predictors of POCD is required.
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Affiliation(s)
- Tracey Bowden
- School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Catherine S Hurt
- School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1V 0HB, UK.,The William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.,School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan, Queensland QLD 4111, Australia
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Nam SW, Oh AY, Koo BW, Kim BY, Han J, Chung SH. Effects of depth of neuromuscular blockade on the BIS-guided propofol requirement: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e26576. [PMID: 34398011 PMCID: PMC8294904 DOI: 10.1097/md.0000000000026576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Deep neuromuscular blockade is considered beneficial for improving the surgical space condition during laparoscopic surgery. Adequacy of the surgical space condition may affect the anesthetists' decision regarding titration of depth of anesthesia. We investigated whether deep neuromuscular blockade reduces the propofol requirement under bispectral index monitoring compared to moderate neuromuscular blockade. METHODS Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to a moderate or deep group. A train-of-four count of 1-2 in the moderate group, and a post-tetanic count of 1-2 in the deep group, were maintained by continuous infusion of rocuronium. The induction and maintenance of anesthesia were achieved by target-controlled infusion of propofol and remifentanil. The dose of propofol was adjusted to maintain the bispectral index in the range of 40-50. The remifentanil dose was titrated to maintain the systolic blood pressure to within 20% of the ward values. RESULTS A total of 82 patients were included in the analyses. The mean±SD dose of propofol was 7.54 ± 1.66 and 7.42 ± 1.01 mg·kg-1·h-1 in the moderate and deep groups, respectively (P = .104). The mean±SD dose of remifentanil was 4.84 ± 1.74 and 4.79 ± 1.77 μg kg-1 h-1 in the moderate and deep groups, respectively (P = .688). In comparison to the moderate group, the deep group showed significantly lower rates of intraoperative patient movement (42.9% vs 22.5%, respectively, P = .050) and additional neuromuscular blocking agent administration (76% vs 53%, respectively, P = .007). Postoperative complications, including pulmonary complications, wound problems and reoperation, were not different between the two groups. CONCLUSION Deep neuromuscular blockade did not reduce the bispectral index-guided propofol requirement compared to moderate neuromuscular blockade during laparoscopic colon surgery, despite reducing movement of the patient and the requirement for a rescue neuromuscular blocking agent. TRIAL REGISTRATION Clinicaltrials.gov (NCT03890406).
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Affiliation(s)
- Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Bo Young Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jiwon Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Sung Hoon Chung
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
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Sun J, Zhou X, Wu J, Xiao R, Chen Y, Lu Y, Lang H. Ligustilide enhances hippocampal neural stem cells activation to restore cognitive function in the context of postoperative cognitive dysfunction. Eur J Neurosci 2021; 54:5000-5015. [PMID: 34192824 DOI: 10.1111/ejn.15363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022]
Abstract
Ligustilide exerts potential neuroprotective effects against various cerebral ischaemic insults and neurodegenerative disorders. However, the function and mechanisms of LIG-mediated hippocampal neural stem cells (H-NSCs) activation as well as cognitive recovery in the context of post-operative cognitive dysfunction (POCD) remain elusive and need to be explored. Mice were subjected to transient global cerebral ischaemia and reperfusion (tGCI/R) injury and treated with LIG (80 mg/kg) or vehicle for 1 month. Morris water maze test and western blot were employed to assess cognitive function. Nissl staining and immunofluorescence (IF) staining were used to detect H-NSCs proliferation and neurogenesis in hippocampus. Subsequently, primary H-NSCs were treated with LIG, and the level of H-NSCs proliferation and neuronal-differentiation was examined by IF staining for Edu and β-Tubulin III. The protein levels of ERK1/2, β-catenin, NICD, TLR4, Akt and FoxO1 were examined using western blotting. Finally, pretreatment with the ERK agonist SCH772984 was performed to observe the change in ERK expression. LIG treatment promoted H-NSCs proliferation and neurogenesis, increased the number of neurons in the hippocampal subfields, and ultimately reversed cognitive impairment in tGCI/R injury. Furthermore, LIG also promoted primary H-NSCs proliferation and neuronal-differentiation, as well as ERK1/2 phosphorylation. Pretreatment with SCH772984 effectively reversed the ability of LIG to induce ERK1/2 phosphorylation and promote H-NSCs proliferation and neuronal-differentiation. LIG can promote cognitive recovery after tGCI/R injury by activating ERK1/2 in H-NSCs to promote their proliferation and neurogenesis in the hippocampus. Therefore, LIG has potential for use in the prevention and/or treatment of POCD.
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Affiliation(s)
- Jing Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Zhou
- Department of Neurosurgery, The Fifth Affiliated Hospital of Nanchang University, Fuzhou, China
| | - Jusheng Wu
- Department of Anesthesiology, The Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Renjie Xiao
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yimei Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haili Lang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Liang CS, Bai YM, Hsu JW, Huang KL, Chu CS, Yeh TC, Tsai SJ, Chen TJ, Chen MH. The Risk of Alzheimer's Disease After Acute Appendicitis With or Without Appendectomy. J Am Med Dir Assoc 2021; 23:601-607.e2. [PMID: 34265267 DOI: 10.1016/j.jamda.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous epidemiologic studies have suggested an association between appendectomy and Parkinson's disease. The aim of the current study was to examine the risk of Alzheimer's disease (AD) and other types of dementia following appendicitis or appendectomy for appendicitis. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS We used claims data from the Taiwan National Health Insurance Research Database. Participants aged ≥45 years with acute appendicitis or who received appendectomy for appendicitis were enrolled and followed up for more than 15 years. Cases and controls underwent 1:1 matching by age, sex, index date, and dementia-related comorbidities. METHODS The primary outcome was AD, and secondary outcomes included other dementia types. Adjusted hazard ratios (aHRs) were calculated, and a competing risk regression model was created. The E value for causality of evidence was calculated. RESULTS Patients developing appendicitis (0.6% vs 0.1%, P = .005) and those receiving appendectomy for appendicitis (0.4% vs 0.1%, P = .003) had higher incidences of AD than the controls during the follow-up period. A Cox regression analysis with adjustment for potential confounders showed that patients with appendicitis [aHR 6.68, 95% confidence interval (CI) 1.84-24.48] and those receiving appendectomy for appendicitis (aHR 5.01, 95% CI 1.33-18.85) were more likely to develop AD than the controls. These 2 groups also had higher risks for unspecified dementia and all types of dementia but not for vascular dementia than the controls. The age at dementia diagnosis was 88.51 years in the controls; however, among people who developed dementia following appendicitis, the mean age at diagnosis was 70.18 years, and dementia occurred 5.84 years after appendicitis. The competing risk regression models and the E values support the study findings. CONCLUSIONS AND IMPLICATIONS After recovery from appendicitis, these patients should be followed up for signs of AD.
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Affiliation(s)
- Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
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Tomasi R, Klemm M, Hinske CL, Hulde N, Schramm R, Zwißler B, von Dossow V. Impairment of Cognitive Function in Different Domains Early After Lung Transplantation. J Clin Psychol Med Settings 2021; 29:103-112. [PMID: 34009540 PMCID: PMC8924110 DOI: 10.1007/s10880-021-09787-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/18/2022]
Abstract
In this prospective observational pilot study patients with the diagnosis of end-stage lung disease and listed for lung transplantation underwent a cognitive function test battery before and after lung transplantation to investigate postoperative cognitive function in three domains (visual and verbal memory, executive functioning, concentration/speed of processing). Additionally we investigated intraoperative risk factors for postoperative cognitive dysfunction. In total, 24 patients were included in this pilot study. The incidence of postoperative cognitive dysfunction was 58.3%. In the cognitive dysfunction group, the domains executive functioning and concentration/attention were significantly impaired whereas memory was not affected. Patients with cognitive impairment had a significantly longer ICU stay. The strongest independent risk factor for the development of cognitive dysfunction was operation time. No influence of cerebral oxygen desaturations on cognitive dysfunction was found. This might have important implications for early psychological rehabilitation strategies in this high-risk patient collective.
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Affiliation(s)
- Roland Tomasi
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Klemm
- Clinic of Cardiology, University of Munich, LMU Munich, Munich, Germany
| | | | - Nikolai Hulde
- Institute of Anaesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bochum, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University, Bochum, Germany
| | - Bernhard Zwißler
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Vera von Dossow
- Institute of Anaesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bochum, Germany.
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Ince I, Chiu A, Sagir A, Chahar P, Lin J, Douglas A, Adi A, Fang J, Mao G, Turan A. Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study. J Cardiothorac Vasc Anesth 2021; 35:3021-3026. [PMID: 34148803 DOI: 10.1053/j.jvca.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors aimed to evaluate the effects of postoperative pain on the incidence of atrial fibrillation and delirium in patients having surgery with cardiopulmonary bypass (CPB). DESIGN Post hoc analysis of the (An investigator-initiated, multicentre, double-blind trial (ClinicalTrials NCT02004613) (DECADE)), a randomized, placebo-controlled trial. SETTING Tertiary, academic hospital. PARTICIPANTS Six hundred five adults from the DECADE enrolled at Cleveland Clinic Main Campus, who had had surgery with CPB. INTERVENTIONS Dexmedetomidine versus placebo started before surgical incision and postoperatively was maintained until 24 hours. MEASUREMENTS Primary outcomes were atrial fibrillation, diagnosed by clinicians in the intensive care unit (ICU), presence of delirium assessed with the Confusion Assessment Method for the ICU, data on pain scores, and opioid consumption, occurring between ICU admission and the earlier of postoperative day five or hospital discharge. RESULTS Postoperative pain levels were similar among patients with or without atrial fibrillation. Two hundred six (34%) patients had atrial fibrillation and ninety-two (15%) had delirium before hospital discharge within the first five postoperative days. The risk of atrial fibrillation was not significantly different between groups (hazard ratio: 1.09; 97.5% confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no associations between postoperative pain and the risk of postoperative delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57). Postoperative opioid consumption was neither significantly associated with postoperative atrial fibrillation nor delirium. CONCLUSIONS Atrial fibrillation and delirium was not associated with pain after cardiac surgery. Opioid use was not associated with atrial fibrillation and delirium. Because both atrial fibrillation and delirium have a multifactorial nature, further studies should be focused on other plausible mechanisms.
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Affiliation(s)
- Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Andrew Chiu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Afrin Sagir
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Praveen Chahar
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jia Lin
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Aaron Douglas
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Ahmad Adi
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jonathan Fang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Guangmei Mao
- Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH.
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Blokzijl F, Keus F, Houterman S, Dieperink W, van der Horst ICC, Reneman MF, Absalom AR, Mariani MA. Does postoperative cognitive decline after coronary bypass affect quality of life? Open Heart 2021; 8:openhrt-2020-001569. [PMID: 33888591 PMCID: PMC8070880 DOI: 10.1136/openhrt-2020-001569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to explore the influence of coronary artery bypass grafting (CABG) on both postoperative cognitive dysfunction and quality of life (QoL) and the association between the two patient-related outcomes. METHODS In a prospective, observational cohort study, patients with elective, isolated CABG were included. Cognitive function was assessed using the Cogstate computerised cognitive test battery preoperatively, 3 days and 6 months after surgery. QoL was measured preoperatively and at 6 months using the RAND-36 questionnaire including the Physical Component Score (PCS) and the Mental Component Score (MCS). Regression analysis, with adjustment for confounders, was used to evaluate the association between postoperative cognitive dysfunction and QoL. RESULTS A total of 142 patients were included in the study. Evidence of persistent cognitive dysfunction was observed in 33% of patients after 6 months. At 6 months, the PCS had improved in 59% and decreased in 21% of patients, and the MCS increased in 49% and decreased in 29%. Postoperative cognitive changes were not associated with QoL scores. CONCLUSIONS Postoperative cognitive dysfunction and decreased QoL are common 6 months after surgery, although cognitive function and QoL were found to have improved in many patients at 6 months of follow-up. Impaired cognitive function is not associated with impaired QoL at 6 months. TRIAL REGISTRATION NUMBER NCT03774342.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem Dieperink
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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Intranasal Insulin Administration to Prevent Delayed Neurocognitive Recovery and Postoperative Neurocognitive Disorder: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052681. [PMID: 33799976 PMCID: PMC7967645 DOI: 10.3390/ijerph18052681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
Delayed neurocognitive recovery and postoperative neurocognitive disorders are major complications of surgery, hospitalization, and anesthesia that are receiving increasing attention. Their incidence is reported to be 10–80% after cardiac surgery and 10–26% after non-cardiac surgery. Some of the risk factors include advanced age, level of education, history of diabetes mellitus, malnutrition, perioperative hyperglycemia, depth of anesthesia, blood pressure fluctuation during surgery, chronic respiratory diseases, etc. Scientific evidence suggests a causal association between anesthesia and delayed neurocognitive recovery or postoperative neurocognitive disorders, and various pathophysiological mechanisms have been proposed: mitochondrial dysfunction, neuroinflammation, increase in tau protein phosphorylation, accumulation of amyloid-β protein, etc. Insulin receptors in the central nervous system have a non-metabolic role and act through a neuromodulator-like action, while an interaction between anesthetics and central nervous system insulin receptors might contribute to anesthesia-induced delayed neurocognitive recovery or postoperative neurocognitive disorders. Acute or chronic intranasal insulin administration, which has no influence on the blood glucose concentration, appears to improve working memory, verbal fluency, attention, recognition of objects, etc., in animal models, cognitively healthy humans, and memory-impaired patients by restoring the insulin receptor signaling pathway, attenuating anesthesia-induced tau protein hyperphosphorylation, etc. The aim of this review is to report preclinical and clinical evidence of the implication of intranasal insulin for preventing changes in the brain molecular pattern and/or neurobehavioral impairment, which influence anesthesia-induced delayed neurocognitive recovery or postoperative neurocognitive disorders.
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Lomivorotov VV, Moroz G, Abubakirov M, Osinsky R, Landoni G. Volatile and Intravenous Anesthetics for Brain Protection in Cardiac Surgery: Does the Choice of Anesthesia Matter? J Cardiothorac Vasc Anesth 2021; 36:567-576. [PMID: 33766470 DOI: 10.1053/j.jvca.2021.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022]
Abstract
Postoperative neurologic complications have a significant effect on morbidity, mortality, and long-term disability in patients undergoing cardiac surgery. The etiology of brain injury in patients undergoing cardiac surgery is multifactorial and remains unclear. There are several perioperative causative factors for neurologic complications, including microembolization, hypoperfusion, and systemic inflammatory response syndrome. Despite technologic advances and the development of new anesthetic drugs, there remains a high rate of postoperative neurologic complications. Moreover, despite the strong evidence that volatile anesthesia exerts cardioprotective effects in patients undergoing cardiac surgery, the neuroprotective effects of volatile agents remain unclear. Several studies have reported an association of using volatile anesthetics with improvement of biochemical markers of brain injury and postoperative neurocognitive function. However, there is a need for additional studies to define the optimal anesthetic drug for protecting the brain in patients undergoing cardiac surgery.
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Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Department of Anesthesiology and Intensive Care, Novosibirsk State University, Novosibirsk, Russia.
| | - Gleb Moroz
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Marat Abubakirov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Roman Osinsky
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Validation of Cognitive Impairment in Combination With Physical Frailty as a Predictor of Mortality in Patients With Advanced Heart Failure Referred for Heart Transplantation. Transplantation 2021; 106:200-209. [PMID: 33988342 DOI: 10.1097/tp.0000000000003669] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to validate our previous finding that frailty predicts early mortality in patients with advanced heart failure (AHF) and that including cognition in the frailty assessment enhances the prediction of mortality. METHODS Patients with AHF referred to our Transplant Unit between November 2015 and April 2020 underwent physical frailty assessment using the modified Fried physical frailty (PF) phenotype as well as cognitive assessment using the Montreal Cognitive Assessment (MOCA) to identify patients who were cognitively frail (CogF). We assessed the predictive value of the 2 frailty measures (PF ≥ 3 of 5 = frail; CogF ≥ 3 of 6 = frail) for pretransplant mortality. RESULTS 313 patients (233 male, 80 female; age 53 ± 13 years) were assessed. Of these, 224 patients (72%) were nonfrail and 89 (28%) were frail using the PF. The cognitive frailty assessment identified an additional 30 patients as frail: 119 (38%). Frail patients had significantly increased mortality as compared to nonfrail patients. Ventricular assist device and heart transplant-censored survival at 12 months was 92 ± 2 % for nonfrail and 69 ± 5% for frail patients (p < 0.0001) using the CogF instrument. CONCLUSIONS This study validates our previously published findings that frailty is prevalent in patients with advanced heart failure referred for heart transplantation. Physical frailty predicts early mortality. The addition of cognitive assessment to the physical assessment of frailty identifies an additional cohort of patients with a similarly poor prognosis.
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Abstract
PURPOSE OF REVIEW The world's population is ageing. Although regional anaesthesia is well established, it seems there is limited evidence to support its use over general anaesthesia in the elderly. This review aims to examine recent publications of regional anaesthesia in relation to this specific patient subgroup. RECENT FINDINGS There is a paucity of evidence specifically relating to regional anaesthesia in the elderly patient. Studies tend to be small, retrospective and can combine assessment of multiple surgical and anaesthetic techniques in single studies. Surgical stimulus and the associated stress response are linked with an increased risk of morbidity in elderly patients. Regional anaesthesia is associated with reduced morbidity, improved pain scores, improved patient satisfaction and reduced resource allocation. Regional anaesthesia can potentially offset some of the surgical stress response and should be considered as part of a multimodal and, where possible, the primary approach to anaesthesia and analgesia in the elderly patient. SUMMARY Undoubtedly, peripheral nerve blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand these side effects. Future large prospective trials are required to evaluate the duration of action and safety profile of local anaesthetic agents and adjunct agents in the older patient.
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Affiliation(s)
- Eva Corcoran
- Galway University Hospital, Newcastle Road, Galway, Ireland
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