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Soares MR, Mahanna Gabrielli E, Manjarrez EC. The Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium. Med Clin North Am 2024; 108:1101-1117. [PMID: 39341616 DOI: 10.1016/j.mcna.2024.06.001] [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] [Indexed: 10/01/2024]
Abstract
Historically and for ease of classification, the geriatric patient has received a chronologic definition of a person 65 years and older. Chronologic age remains an independent risk of postoperative complications and adverse surgical outcomes. Frailty is an expression of an individual's biological age and as such a more reliable determination of their vulnerabilities or resilience to stress. The concept of prehabilitation has shown promise as a proactive approach to optimize a patient's functional, cognitive, nutritional, and emotional in preparation for surgical interventions. Postoperative delirium is the most common neuropsychological complication after surgery.
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Affiliation(s)
| | - Elizabeth Mahanna Gabrielli
- Division Neuroanesthesiology, Critical Care Medicine, Neurocritical Care and Geriatric Anesthesiology, University of Miami Miller School of Medicine
| | - Efrén C Manjarrez
- Division of Hospital Medicine, University of Miami Miller School of Medicine. https://twitter.com/drefrenm
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Atkins KJ, Silbert B, Scott DA, Evered LA. Prevalence of neurocognitive disorders 5 years after elective orthopaedic surgery. Anaesthesia 2024; 79:1053-1061. [PMID: 38985478 DOI: 10.1111/anae.16365] [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] [Accepted: 05/10/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Peri-operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long-term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre-operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery. METHODS A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests. RESULTS Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery. CONCLUSION More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.
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Affiliation(s)
- Kelly J Atkins
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Brendan Silbert
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - David A Scott
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Lis A Evered
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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Wang S, Zhao J, Wang C, Yao Y, Song Z, Li L, Jiang J. miR-206-3p Targets Brain-Derived Neurotrophic Factor and Affects Postoperative Cognitive Function in Aged Mice. Neurochem Res 2024; 49:2005-2020. [PMID: 38814357 DOI: 10.1007/s11064-024-04174-0] [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: 01/23/2024] [Revised: 04/10/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
Postoperative cognitive dysfunction (POCD) occurs after surgery and severely impairs patients' quality of life. Finding POCD-associated variables can aid in its diagnosis and prognostication. POCD is associated with noncoding RNAs, such as microRNAs (miRNAs), involved in metabolic function, immune response alteration, and cognitive ability impairment; however, the underlying mechanisms remain unclear. The aim of this study was to investigate hub miRNAs (i.e., miRNAs that have an important regulatory role in diseases) regulating postoperative cognitive function and the associated mechanisms. Hub miRNAs were identified by bioinformatics, and their expression in mouse hippocampus tissues was determined using real-time quantitative polymerase chain reaction. Hub miRNAs were overexpressed or knocked down in cell and animal models to test their effects on neuroinflammation and postoperative cognitive function. Six differentially expressed hub miRNAs were identified. miR-206-3p was the only broadly conserved miRNA, and it was used in follow-up studies and animal experiments. Its inhibitors reduced the release of proinflammatory cytokines in BV-2 microglia by regulating its target gene, brain-derived neurotrophic factor (BDNF), and the downstream signaling pathways. miR-206-3p inhibition suppressed microglial activation in the hippocampi of mice and improved learning and cognitive decline. Therefore, miR-206-3p significantly affects POCD, implying its potential as a therapeutic target.
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Affiliation(s)
- Shentong Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Jia Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Chengran Wang
- Department of Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Yuhan Yao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Zhiyao Song
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Longyun Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
| | - Jinlan Jiang
- Department of Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
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Li Y, Li YJ, Fang X, Chen DQ, Yu WQ, Zhu ZQ. Peripheral inflammation as a potential mechanism and preventive strategy for perioperative neurocognitive disorder under general anesthesia and surgery. Front Cell Neurosci 2024; 18:1365448. [PMID: 39022312 PMCID: PMC11252726 DOI: 10.3389/fncel.2024.1365448] [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: 01/04/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
General anesthesia, as a commonly used medical intervention, has been widely applied during surgical procedures to ensure rapid loss of consciousness and pain relief for patients. However, recent research suggests that general anesthesia may be associated with the occurrence of perioperative neurocognitive disorder (PND). PND is characterized by a decline in cognitive function after surgery, including impairments in attention, memory, learning, and executive functions. With the increasing trend of population aging, the burden of PND on patients and society's health and economy is becoming more evident. Currently, the clinical consensus tends to believe that peripheral inflammation is involved in the pathogenesis of PND, providing strong support for further investigating the mechanisms and prevention of PND.
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Affiliation(s)
- Yuan Li
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Anesthesiology, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Ying-Jie Li
- Department of General Surgery, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Xu Fang
- Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical School of North Sichuan Medical College, Zunyi, China
| | - Dong-Qin Chen
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wan-Qiu Yu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhao-Qiong Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Early Clinical Research Ward of Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Stern M, Kok WF, Doorduin J, Jongman RM, Jainandunsing J, Nieuwenhuijs-Moeke GJ, Absalom AR, Henning RH, Bosch DJ. Mild and deep hypothermia differentially affect cerebral neuroinflammatory and cold shock response following cardiopulmonary bypass in rat. Brain Behav Immun 2024; 119:96-104. [PMID: 38555988 DOI: 10.1016/j.bbi.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Targeted temperature management (TTM) is considered to be a neuroprotective strategy during cardiopulmonary bypass (CPB) assisted procedures, possibly through the activation of cold shock proteins. We therefore investigated the effects of mild compared with deep hypothermia on the neuroinflammatory response and cold shock protein expression after CPB in rats. METHODS Wistar rats were subjected to 1 hr of mild (33 °C) or deep (18 °C) hypothermia during CPB or sham procedure. PET scan analyses using TSPO ligand [11C]PBR28 were performed on day 1 (short-term) or day 3 and 7 post-procedure (long-term) to assess neuroinflammation. Hippocampal and cortical samples were obtained at day 1 in the short-term group and at day 7 in the long-term group. mRNA expression of M1 and M2 microglia associated cytokines was analysed with RT-PCR. Cold shock protein RNA-binding motive 3 (RBM3) and tyrosine receptor kinase B (TrkB) receptor protein expression were determined with Western Blot and quantified. RESULTS In both groups target temperature was reached within an hour. Standard uptake values (SUV) of [11C]PBR28 in CPB rats at 1 day and 3 days were similar to that of sham animals. At 7 days after CPB the SUV was significantly higher in amygdala and hippocampal regions of the CPB 18 °C group as compared to the CPB 33 °C group. No differences were observed in the expression of M1 and M2 microglia-related cytokines between TTM 18 °C and 33 °C. RBM3 protein levels in cortex and hippocampus were significantly higher in CPB 33 °C compared to CPB 18 °C and sham 33 °C, at day 1 and day 7, respectively. CONCLUSIONS TTM at 18 °C increased the neuroinflammatory response in amygdala and hippocampus compared to TTM at 33 °C in rats undergoing a CPB procedure. Additionally, TTM at 33 °C induced increased expression of TrkB and RBM3 in cortex and hippocampus of rats on CPB compared to TTM at 18 °C. Together, these data indicate that neuroinflammation is alleviated by TTM at 33 °C, possibly by recruiting protective mechanisms through cold shock protein induction.
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Affiliation(s)
- Manon Stern
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Wendelinde F Kok
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Rianne M Jongman
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Jayant Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Gertrude J Nieuwenhuijs-Moeke
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Anthony R Absalom
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - R H Henning
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Dirk J Bosch
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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Chen Z, Meng B, Li X, Lu B, Zhai X, Wang R, Chen J. Boston Naming Test as a Screening Tool for Early Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery. Am Surg 2024:31348241260274. [PMID: 38848748 DOI: 10.1177/00031348241260274] [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: 06/09/2024]
Abstract
PURPOSE The Boston naming test (BNT), as a simple, fast, and easily administered neuropsychological test, was demonstrated to be useful in detecting language function. In this study, BNT was investigated whether it could be a screening tool for early postoperative cognitive dysfunction (POCD). METHODS This prospective observational cohort study included 132 major noncardiac surgery patients and 81 nonsurgical controls. All participants underwent a mini-mental state examination (MMSE) and BNT 1 day before and 7 days after surgery. Early POCD was assessed by reliable change index and control group results. RESULTS Seven days after surgery, among 132 patients, POCD was detected in 30 (22.7%) patients (95% CI, 15.5%-30.0%) based on MMSE, and 45 (34.1%) patients (95% CI, 26.3%-41.9%) were found with postoperative language function decline based on BNT and MMSE. Agreement between the BNT spontaneous naming and MMSE total scoring was moderate (Kappa .523), and the sensitivity of BNT spontaneous naming for detecting early POCD was .767. Further analysis showed that areas under receiver operating characteristics curves (AUC) did not show statistically significant differences when BNT spontaneous naming (AUC .862) was compared with MMSE language functional subtests (AUC .889), or non-language functional subtests (AUC .933). CONCLUSION This study indicates the feasibility of implementing the BNT spontaneous naming test to screen early POCD in elderly patients after major noncardiac surgery.
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Affiliation(s)
- Zhang Chen
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Bo Meng
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Xiaoyu Li
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Bo Lu
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Xiaojie Zhai
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Ruichun Wang
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
| | - Junping Chen
- Department of Anesthesiology, Ningbo No.2 Hospital, Haishu District, Ningbo, China
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Tang AB, Diaz-Ramirez LG, Boscardin WJ, Smith AK, Ward D, Glymour MM, Whitlock EL. Long-term cognitive outcome after elective hip or knee total joint arthroplasty: A population-based observational study. J Am Geriatr Soc 2024; 72:1338-1347. [PMID: 38190295 PMCID: PMC11090741 DOI: 10.1111/jgs.18724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND One year after elective hip or knee total joint arthroplasty (TJA), >30% of older adults meet criteria for postoperative neurocognitive disorder. However, this is not contextualized with long-term cognitive outcomes in comparable surgical and nonsurgical controls. We analyzed population-based data to compare long-term cognitive outcomes in older adults after TJA, other surgeries, and with and without arthritis pain. METHODS This was a retrospective observational analysis of United States older adults in the Health and Retirement Study (HRS) who underwent elective TJA, or elective surgery without expected functional benefits (e.g., cholecystectomy; inguinal herniorrhaphy), between 1998 and 2018 at aged 65 or older. TJA recipients were also age- and sex-matched to nonsurgical controls who reported moderate-severe arthritic pain or denied pain, so that comparison groups included surgical and nonsurgical (pain-suffering and pain-free) controls. We modeled biennially-assessed memory performance, a measure of direct and proxy cognitive assessments, before and after surgery, normalized to the rate of memory decline ("cognitive aging") in controls to express effect size estimates as excess, or fewer, months of memory decline. We used linear mixed effects models adjusted for preoperative health and demographic factors, including frailty, flexibly capturing time before/after surgery (knots at -4, 0, 8 years; discontinuity at surgery). RESULTS There were 1947 TJA recipients (average age 74; 63% women; 1358 knee, 589 hip) and 1631 surgical controls (average age 76; 38% women). Memory decline 3 years after TJA was similar to surgical controls (5.2 [95% confidence interval, CI -1.2 to 11.5] months less memory decline in the TJA group, p = 0.11) and nonsurgical controls. At 5 years, TJA recipients experienced 5.0 [95% CI -0.9 to 10.9] months less memory decline than arthritic pain nonsurgical controls. CONCLUSION There is no systematic accelerated memory decline at 3 years after TJA compared with surgical or nonsurgical controls.
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Affiliation(s)
- Angelina B Tang
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Derek Ward
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - M Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, California, USA
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Oliveri S, Bocci T, Maiorana NV, Guidetti M, Cimino A, Rosci C, Ghilardi G, Priori A. Cognitive trajectories after surgery: Guideline hints for assessment and treatment. Brain Cogn 2024; 176:106141. [PMID: 38458027 DOI: 10.1016/j.bandc.2024.106141] [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: 11/29/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical "trauma". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage. Moreover, pre-existing Mild Cognitive Impairment, alcohol or drugs consumption, depression and other factors, together with several intraoperative and post-operative sequelae, can exacerbate the severity and duration of NCDs. In this context it is crucial rely on current progresses in serum and CSF biomarker analysis to frame neuroinflammation levels, along with establishing standard protocol for neuropsychological assessment (with specific set of tools) and to apply cognitive training or neuromodulation techniques to reduce the incidence of postoperative NCDs when required. It is recommended to identify those patients who would need such preventive intervention early, by including them in pre-operative and post-operative comprehensive evaluation and prevent the development of a full-blown dementia after surgery. This contribution reports all the recent progresses in the NCDs diagnostic classification, pathogenesis discoveries and possible treatments, with the aim to systematize current evidences and provide guidelines for multidisciplinary care.
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Affiliation(s)
- Serena Oliveri
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy.
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Natale Vincenzo Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy
| | - Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy
| | - Andrea Cimino
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Italy; Neurosurgery Unit, Neuroscience Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Rosci
- Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Giorgio Ghilardi
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Italy; General Surgery Unit, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics Department of Health Sciences, University of Milan, Italy; Neurological Clinic, Azienda Socio Sanitaria Territoriale - Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
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Deng L, Gao R, Chen H, Jiao B, Zhang C, Wei L, Yan C, Ye-Lehmann S, Zhu T, Chen C. Let-7b-TLR7 Signaling Axis Contributes to the Anesthesia/Surgery-Induced Cognitive Impairment. Mol Neurobiol 2024; 61:1818-1832. [PMID: 37782443 DOI: 10.1007/s12035-023-03658-4] [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: 04/10/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
Perioperative neurocognitive disorders (PNDs) are severe and common neurological complications among elderly patients following anesthesia and surgery. As the first line of defense of the innate immune system, Toll-like receptors (TLRs) have been found to be involved in the occurrence of neurodegenerative diseases in recent years. However, the role of TLR7 in the pathology and development of PNDs remains largely unclear. In our current study, we hypothesized that increased microRNA let-7b (let-7b) during anesthesia and surgical operation would activate TLR7 signaling pathways and mediate PNDs. Using a mouse model of PNDs, 18-20 months wild-type (WT) mice were undergoing unilateral nephrectomy, and increased TLR7 and let-7b expression levels were found in the surgery group compared with the Sham group. Of note, increased TLR7 was found to be co-localized with let-7b in the hippocampal area CA1 in the PNDs model. In addition, TLR7 and let-7b inhibition could improve hippocampus-dependent memory and attenuate the production of inflammatory cytokines. Together, our results indicated that TLR7 activation and up-regulation might be triggered by increased let-7b under stressful conditions and initiated the downstream inflammatory signaling, playing a substantial role in the development of PNDs.
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Affiliation(s)
- Liyun Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Gao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Chen
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Jiao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Changteng Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Liuxing Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Caiyi Yan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Shixin Ye-Lehmann
- Unité INSERM U1195, Diseases and Hormones of the Nervous System, University of Paris-Scalay, Bicêtre Hosptial, Bât. Grégory Pincus, Le Kremlin-Bicêtre, France
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China.
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10
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Collins CR, Campbell A. Surgery, Anesthesia, and TBI Outcomes-Unraveling the Complex Interplay. JAMA Surg 2024; 159:259. [PMID: 38091018 DOI: 10.1001/jamasurg.2023.6371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Caitlin R Collins
- Department of Surgery, School of Medicine, University of California, San Francisco
| | - Andre Campbell
- Department of Surgery, School of Medicine, University of California, San Francisco
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Joo H, Li LY, Whitlock EL. Long-term cognitive outcomes after surgery and anesthesia: what we find depends on where we look. CURRENT ANESTHESIOLOGY REPORTS 2024; 14:8-14. [PMID: 38784119 PMCID: PMC11115381 DOI: 10.1007/s40140-023-00590-0] [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] [Accepted: 11/13/2023] [Indexed: 05/25/2024]
Abstract
Purpose of review To review how anecdote and narrative medicine, primary cohort studies, epidemiological studies, and the dementia literature can be bridged to understand long-term postoperative cognitive decline. Recent findings Primary cohort studies have measured recoverable declines in memory and executive function after major surgery, but less-appreciated sources also offer critical insights. Anecdote reveals that functionally-impactful cognitive decline may persist after physical recovery in some patients despite modern medications and monitoring, and that physicians are unprepared to address patients' cognitive concerns. However, epidemiological studies reproducibly demonstrate that elective surgery has no, or a negligible, average impact on cognition in older patients. Cognitively provocative factors - like medical hospital admissions or health factors like diabetes and smoking - are common in late life, and surgery likely contributes minimally to long-term cognitive change for most patients. Summary Patients should be reassured that, while anecdotes of durable cognitive change after surgery are easily accessible, most patients experience cognitive recovery after major surgery. However, those who do not recover deserve characterization of their symptoms and investigation of modifiable causes to facilitate cognitive recovery.
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Affiliation(s)
- Hyundeok Joo
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Y Li
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
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Roberts CJ, Barber J, Temkin NR, Dong A, Robertson CS, Valadka AB, Yue JK, Markowitz AJ, Manley GT, Nelson LD. Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study. JAMA Surg 2024; 159:248-259. [PMID: 38091011 PMCID: PMC10719833 DOI: 10.1001/jamasurg.2023.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/04/2023] [Indexed: 12/17/2023]
Abstract
Importance Traumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders. Objective To examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI. Design, Setting, and Participants This study was a retrospective, secondary analysis of data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective cohort study that assessed longitudinal outcomes of participants enrolled at 18 level I US trauma centers between February 1, 2014, and August 31, 2018. Participants were 17 years or older, presented within 24 hours of trauma, were admitted to an inpatient unit from the emergency department, had known Glasgow Coma Scale (GCS) and head computed tomography (CT) status, and did not undergo cranial surgery. This analysis was conducted between January 2, 2020, and August 8, 2023. Exposure Participants who underwent EC surgery during the index admission were compared with participants with no surgery in groups with a peripheral orthopedic injury or a TBI and were classified as having uncomplicated mild TBI (GCS score of 13-15 and negative CT results [CT- mTBI]), complicated mild TBI (GCS score of 13-15 and positive CT results [CT+ mTBI]), or moderate to severe TBI (GCS score of 3-12 [m/sTBI]). Main Outcomes and Measures The primary outcomes were functional limitations quantified by the Glasgow Outcome Scale-Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI) and neurocognitive outcomes at 2 weeks and 6 months after injury. Results A total of 1835 participants (mean [SD] age, 42.2 [17.8] years; 1279 [70%] male; 299 Black, 1412 White, and 96 other) were analyzed, including 1349 nonsurgical participants and 486 participants undergoing EC surgery. The participants undergoing EC surgery across all TBI severities had significantly worse GOSE-ALL scores at 2 weeks and 6 months compared with their nonsurgical counterparts. At 6 months after injury, m/sTBI and CT+ mTBI participants who underwent EC surgery had significantly worse GOSE-TBI scores (B = -1.11 [95% CI, -1.53 to -0.68] in participants with m/sTBI and -0.39 [95% CI, -0.77 to -0.01] in participants with CT+ mTBI) and performed worse on the Trail Making Test Part B (B = 30.1 [95% CI, 11.9-48.2] in participants with m/sTBI and 26.3 [95% CI, 11.3-41.2] in participants with CT+ mTBI). Conclusions and Relevance This study found that exposure to EC surgery and anesthesia was associated with adverse functional outcomes and impaired executive function after TBI. This unfavorable association warrants further investigation of the potential mechanisms and clinical implications that could inform decisions regarding the timing of surgical interventions in patients after TBI.
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Affiliation(s)
- Christopher J. Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Athena Dong
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | | | - Alex B. Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, San Francisco, California
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
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Dilmen OK, Meco BC, Evered LA, Radtke FM. Postoperative neurocognitive disorders: A clinical guide. J Clin Anesth 2024; 92:111320. [PMID: 37944401 DOI: 10.1016/j.jclinane.2023.111320] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/14/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
For years, postoperative cognitive outcomes have steadily garnered attention, and in the past decade, they have remained at the forefront. This prominence is primarily due to empirical research emphasizing their potential to compromise patient autonomy, reduce quality of life, and extend hospital stays, and increase morbidity and mortality rates, especially impacting elderly patients. The underlying pathophysiological process might be attributed to surgical and anaesthesiological-induced stress, leading to subsequent neuroinflammation, neurotoxicity, burst suppression and the development of hypercoagulopathy. The beneficial impact of multi-faceted strategies designed to mitigate the surgical and perioperative stress response has been suggested. While certain potential risk factors are difficult to modify (e.g., invasiveness of surgery), others - including a more personalized depth of anaesthesia (EEG-guided), suitable analgesia, and haemodynamic stability - fall under the purview of anaesthesiologists. The ESAIC Safe Brain Initiative research group recommends implementing a bundle of non-invasive preventive measures as a standard for achieving more patient-centred care. Implementing multi-faceted preoperative, intraoperative, and postoperative preventive initiatives has demonstrated the potential to decrease the incidence and duration of postoperative delirium. This further validates the importance of a holistic, team-based approach in enhancing patients' clinical and functional outcomes. This review aims to present evidence-based recommendations for preventing, diagnosing, and treating postoperative neurocognitive disorders with the Safe Brain Initiative approach.
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Affiliation(s)
- Ozlem Korkmaz Dilmen
- Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anaesthesiology and Intensive Care, Istanbul, Turkey.
| | - Basak Ceyda Meco
- Ankara University, Department of Anaesthesiology and Intensive Care, Ankara, Turkey
| | - Lisbeth A Evered
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Finn M Radtke
- Associate Professor, Head of Research Department of Anaesthesia and Intensive Care, Nykoebing Hospital, University of Southern Denmark, SDU, Guest Researcher at Charité, Berlin, Germany
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14
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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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15
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Song K, Zhang R, Zhao X, Yang L, Wang Q, Gao W. Perioperative neurocognitive disorder changes in elderly diabetes patients within 30 days after surgery: a retrospective cohort study. Aging Clin Exp Res 2023; 35:2911-2918. [PMID: 37847351 DOI: 10.1007/s40520-023-02583-9] [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: 05/05/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Perioperative neurocognitive disorders (PND) are a common central nervous system complication that predominantly affects the elderly. PND after surgery includes postoperative delirium (POD), delayed neurocognitive recovery up to 30 days (DNR), and postoperative neurocognitive disorder up to 12 months. Diabetes is an important independent risk factor for PND. Over the years, few studies have assessed the incidence of PND and the difference in serum biomarkers between diabetic and non-diabetic patients. We sought to examine the difference in the incidence of PND between elderly diabetic and non-diabetic patients in China and identify the risk factors of PND in elderly diabetics. METHODS We conducted a secondary and exploratory data analysis from our prior studies, including patients aged 65 years or older who underwent non-cardiac elective surgery with general anesthesia. We used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Montreal Cognitive Assessment (MoCA) to assess patient cognition. RESULTS A total of 236 patients were analyzed; the incidence of PND was significantly higher in diabetic than in non-diabetic patients within 30 days (59.2% vs. 36.8%) (P = 0.022). Multivariate logistic regression analysis showed that the preoperative MoCA was an independent risk factor for PND (odds ratio, 0.88 [0.8 to 0.97]; P = 0.014), and Hosmer-Lemeshow tests showed that it could predict PND in diabetic patients (P = 0.360). According to the maximum Youden index, the optimal cutoff for preoperative MoCA was 21.5 points, yielding a specificity and sensitivity of 88.0% and 55.2% for PND. The levels of glial fibrillary acidic protein (GFAP) and Tau in diabetic patients before and after surgery were significantly higher than in non-diabetic patients among cases of PND (P = 0.002 and 0.011, respectively). CONCLUSION The incidence of PND is higher in diabetic than in non-diabetic patients in China, and preoperative MoCA is an independent risk factor for PND in diabetics. Meanwhile, the changes in GFAP and p-Tau in diabetic patients who experienced PND were significantly higher than in non-diabetic ones.
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Affiliation(s)
- Keke Song
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Rongrong Zhang
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Xiaoqi Zhao
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Lan Yang
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Qiang Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Wei Gao
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, China.
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Ölmeztürk Karakurt TC, Kuyrukluyıldız U, Onk D, Ünver S, Arslan YK. Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery. DIE ANAESTHESIOLOGIE 2023; 72:19-24. [PMID: 35024878 DOI: 10.1007/s00101-021-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/24/2021] [Accepted: 11/18/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. MATERIAL AND METHODS The study sample consisted of 80 patients aged 18-65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. RESULTS The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). CONCLUSION The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.
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Affiliation(s)
- Tülay Ceren Ölmeztürk Karakurt
- Mengücek Gazi Training and Research Hospital, Anesthesiology and Reanimation Clinic, Erzincan Binali Yıldırım University, Erzincan, Turkey.
| | - Ufuk Kuyrukluyıldız
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Didem Onk
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Süheyla Ünver
- Dr.Abdurrahman Yurtarslan Oncology Training and Research Hospital, Department of Anesthesiology and Reanimation, Health Sciences University, Ankara, Turkey
| | - Yusuf Kemal Arslan
- Faculty of Medicine, Department of Biostatistics, Erzincan Binali Yıldırım University, Erzincan, Turkey
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Erwin ER, Ray KS, Han S. The hidden impact of orthopedic surgeries: Examining the psychological consequences. J Clin Orthop Trauma 2023; 47:102313. [PMID: 38196498 PMCID: PMC10772377 DOI: 10.1016/j.jcot.2023.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
Orthopedic surgery is commonly considered "quality of life care," as most orthopedic procedures have been shown to provide excellent pain relief and successful surgical outcomes for patients. Although orthopedic surgeries continue to improve patients' functional outcomes through modern surgical techniques and preoperative psychological screening, variation in patient function persists in current studies. Sub-optimal function in patients has been shown to be associated with emotional health burdens, such as anxiety and depression. Previous research has found that preoperative psychological conditions could negatively affect patients' functional outcomes. However, these studies were limited in that they did not examine novel psychological repercussions in emotionally healthy patients following surgery. To address this gap in knowledge, a narrative review was conducted to differentiate specific orthopedic surgeries that have psychological consequences on patients and to determine the current psychological support available for these patients. Data was collected from the Medical Humanities sector of the Texas Medical Center Library and the National Library of Medicine. Studies were included that examined novel psychological effects on patients after undergoing orthopedic surgery. A total of 38 articles were identified, and the majority focused on orthopedic trauma surgery while the rest examined total joint arthroplasty and orthopedic sports procedures. A key finding was that orthopedic trauma surgeries, alone and compared to total joint arthroplasty, result in a greater risk of negative psychological effects, while there was limited data on the psychological effects of orthopedic sports procedures. This narrative review suggests a need to integrate psychosocial support for patients with traumatic orthopedic intervention, regardless of the patient's preoperative psychological state. Furthermore, more research examining the mental well-being of patients following elective orthopedic surgeries is necessary to determine if these operations would benefit from postoperative psychological support as well.
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Affiliation(s)
- Emily R. Erwin
- Department of Orthopedic Surgery, McGovern Medical School, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Keisha S. Ray
- McGovern Center for Humanities & Ethics, McGovern Medical School, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, 6431 Fannin Street, Houston, TX, 77030, USA
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Stern M, Nieuwenhuijs-Moeke GJ, Absalom A, van Leeuwen B, van der Wal-Huisman H, Plas M, Bosch DJ. Association between anaesthesia-related factors and postoperative neurocognitive disorder: a post-hoc analysis. BMC Anesthesiol 2023; 23:368. [PMID: 37950163 PMCID: PMC10636964 DOI: 10.1186/s12871-023-02318-3] [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: 03/24/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery. METHODS We analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score. RESULTS Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8-27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001-1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]). CONCLUSION In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients' scores on cognitive tests improved postoperatively.
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Affiliation(s)
- Manon Stern
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gertrude J Nieuwenhuijs-Moeke
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anthony Absalom
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara van Leeuwen
- Department of Surgery/ Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery/ Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Matthijs Plas
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk J Bosch
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Dammavalam V, Murphy J, Johnkutty M, Elias M, Corn R, Bergese S. Perioperative cognition in association with malnutrition and frailty: a narrative review. Front Neurosci 2023; 17:1275201. [PMID: 38027517 PMCID: PMC10651720 DOI: 10.3389/fnins.2023.1275201] [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: 08/09/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative delirium (POD) is a prevalent clinical entity characterized by reversible fluctuating altered mental status and cognitive impairment with acute and rapid onset a few days after major surgery. Postoperative cognitive decline (POCD) is a more permanent extension of POD characterized by prolonged global cognitive impairment for several months to years after surgery and anesthesia. Both syndromes have been shown to increase morbidity and mortality in postoperative patients making their multiple risk factors targets for optimization. In particular, nutrition imparts a significant and potentially reversible risk factor. Malnutrition and frailty have been linked as risk factors and predictive indicators for POD and less so for POCD. This review aims to outline the association between nutrition and perioperative cognitive outcomes as well as potential interventions such as prehabilitation.
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Affiliation(s)
- Vikalpa Dammavalam
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, United States
| | - Jasper Murphy
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Meenu Johnkutty
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Murad Elias
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, United States
| | - Ryan Corn
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, United States
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, United States
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Yang L, Chen W, Yang D, Chen D, Qu Y, Hu Y, Liu D, He J, Tang Y, Zeng H, Li H, Zhang Y, Ye Z, Liu J, Li Q, Song H. Postsurgery Subjective Cognitive and Short-Term Memory Impairment Among Middle-Aged Chinese Patients. JAMA Netw Open 2023; 6:e2336985. [PMID: 37815831 PMCID: PMC10565601 DOI: 10.1001/jamanetworkopen.2023.36985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023] Open
Abstract
Importance Perioperative neurocognitive disorder, particularly postoperative cognitive impairment, is common and associated with multiple medical and social adversities, although data from China are lacking. Objective To examine the incidence, trajectory, and risk factors for subjective cognitive and short-term memory impairment after surgery in the Chinese population. Design, Setting, and Participants This cohort study used data from the China Surgery and Anesthesia Cohort to assess surgical patients aged 40 to 65 years from 2 medical centers between July 15, 2020, and March 31, 2023, with active follow-up within 1 year after the surgery. Of 11 158 patients who were successfully recruited (response rate, 94.4%), 10 149 participants were eligible and available for analysis. From this population, separate cohorts were constructed for analyzing subjective cognitive impairment (8105 noncardiac and 678 cardiac surgery patients) and short-term memory impairment (5246 noncardiac and 454 cardiac surgery patients). Exposures Twenty-four potential risk factors regarding comorbidities, preoperative psychological conditions, anesthesia- or surgery-related factors, and postsurgical events were included. Main Outcomes and Measures Outcomes included subjective cognitive function measured by the 8-Item Informant Interview to Differentiate Aging and Dementia (AD8; scores range from 0 to 8, with higher scores indicating more severe cognitive impairment) and short-term memory measured by the 3-Word Recall Test (TRT; scores range from 0 to 3, with lower scores indicating more severe short-term memory impairment) at 1, 3, 6, and 12 months after noncardiac and cardiac surgery. Generalized linear mixed models were used to identify risk factors associated with the presence of AD8 (score ≥2) or TRT (score <3) abnormality as well as the aggressively deteriorative trajectories of those cognitive measurements. Results For noncardiac surgery patients, the AD8 analysis included 8105 patients (mean [SD] age, 52.3 [7.1] years; 3378 [41.7%] male), and the TRT analysis included 5246 patients (mean [SD] age, 51.4 [7.0] years; 1969 [37.5%] male). The AD8 abnormality incidence rates after noncardiac surgery increased from 2.2% (175 of 8105) at 7 days to 17.1% (1059 of 6191) at 6 months after surgery, before appearing to decrease. In contrast, the TRT abnormality incidence rates followed a U-shaped pattern, with the most pronounced incidence rates seen at 7 days (38.9% [2040 of 5246]) and 12 months (49.0% [1394 of 2845]). Similar patterns were seen among cardiac surgery patients for the AD8 analysis (678 patients; mean [SD] age, 53.2 [6.3] years; 393 [58.0%] male) and TRT analysis (454 patients; mean [SD] age, 52.4 [6.4] years; 248 [54.6%] male). Among noncardiac surgery patients, the top risk factors for aggressively deteriorative AD8 trajectory and for AD8 abnormality, respectively, after surgery were preoperative sleep disturbances (Pittsburgh Sleep Quality Index ≥16 vs 0-5: odds ratios [ORs], 4.04 [95% CI, 2.20-7.40] and 4.54 [95% CI, 2.40-8.59]), intensive care unit stay of 2 days or longer (ORs, 2.43 [95% CI, 1.26-4.67] and 3.07 [95% CI, 1.67-5.65]), and preoperative depressive symptoms (ORs, 1.76 [95% CI, 1.38-2.24] and 2.23 [95% CI, 1.79-2.77]). Analyses for TRT abnormality and trajectory, as well as the analyses conducted among cardiac surgery patients, found fewer associated factors. Conclusions and Relevance This cohort study of middle-aged Chinese surgery patients found subjective cognitive and short-term memory impairment within 12 months after both cardiac and noncardiac surgery, with multiple identified risk factors, underscoring the potential of preoperative psychological interventions and optimized perioperative management for postoperative cognitive impairment prevention.
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Affiliation(s)
- Lei Yang
- Department of Anesthesiology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenwen Chen
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Di Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Dongxu Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Di Liu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Sichuan University–Pittsburgh Institute, Sichuan University, Chengdu, China
| | - Junhui He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuling Tang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huolin Zeng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Haiyang Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuyang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zi Ye
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Potestio CP, Dibato J, Bolkus K, Awad A, Thayasivam U, Patel A, Bright A, Mitrev LV. Post-Operative Cognitive Dysfunction in Elderly Patients Receiving Propofol Sedation for Gastrointestinal Endoscopies: An Observational Study Utilizing Processed Electroencephalography. Cureus 2023; 15:e46588. [PMID: 37933341 PMCID: PMC10625787 DOI: 10.7759/cureus.46588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Propofol sedation is commonly administered during gastrointestinal (GI) procedures. The Patient State Index (PSI) is a processed electroencephalography (EEG) parameter obtained with the SedLine® Sedation Monitoring system (Masimo Corporation, Irvine, CA). When used to objectively assess the patient's level of consciousness, PSI may provide a more effective, safer titration of sedation during GI procedures. We hypothesize that having more or longer episodes of deep sedation as assessed by PSI (i.e., PSI<26) would correlate with developing new-onset or worsening post-operative cognitive dysfunction (POCD). METHODS This was a pragmatic, double-blinded observational study of 400 patients aged ≥65 years undergoing upper GI endoscopy, lower GI endoscopy, or a combined procedure utilizing propofol sedation at a tertiary-care [A1] academic medical center. The patients were monitored with the SedLine® Brain Function Monitor, software version 2 (Masimo Corporation, Irvine, CA), throughout the case, starting at baseline (i.e., before administration of propofol) and stopping at case end. We assessed the subjects' cognitive function via an in-person interview at baseline (pre-procedure) and telephone interviews at 1, 7 (±1), and 90 days after study enrollment. Cognitive function was assessed by administering the short blessed test (SBT), which is a validated brief cognitive screening appropriate for in-person and telephone administration. RESULTS The correlations between the change in SBT score and the pre-defined parameters of PSI were not significant (all p-values >5%). There was a significant drop in SBT scores on day seven. Higher age was also significantly associated with a drop in SBT from baseline. Deep sedation, as evidenced by the number of times PSI was lower than 26, was not predictive of the change in SBT, nor was gender, total propofol dose, or vasoactive drug use during the procedure. CONCLUSIONS The observed incidence of POCD after GI procedures with propofol sedation was low (1.3% at seven days and 2.95% at 90 days) and lower than at the baseline. Age was associated with a greater average decline in SBT score, although the absolute change was small (-0.067 per year of age increase). Deeper sedation, as documented by the PSI score, was not associated with a change in POCD measured with the SBT.
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Affiliation(s)
| | - John Dibato
- Department of Clinical Biostatistics, Cooper Medical School of Rowan University, Camden, USA
| | - Kelly Bolkus
- Department of Anesthesiology, Cooper University Health Care, Camden, USA
| | - Ahmed Awad
- Department of Anesthesiology, Cooper University Hospital, Camden, USA
| | | | - Avish Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, USA
| | - Anshel Bright
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, USA
| | - Ludmil V Mitrev
- Department of Anesthesiology, Cooper University Hospital, Camden, USA
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Jia S, Yang H, Huang F, Fan W. Systemic inflammation, neuroinflammation and perioperative neurocognitive disorders. Inflamm Res 2023; 72:1895-1907. [PMID: 37688642 DOI: 10.1007/s00011-023-01792-2] [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: 05/29/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023] Open
Abstract
Perioperative neurocognitive disorder (PND) is a common disorder following anesthesia and surgery, especially in the elderly. The complex cellular and molecular processes are involved in PND, but the underlying pathogenesis of which remains inconclusive due to conflicting data. A growing body of evidence has been shown that perioperative systemic inflammation plays important roles in the development of PND. We reviewed the relevant literature retrieved by a search in the PubMed database (on July 20, 2023). The search terms used were "delirium", "post operative cognitive dysfunction", "perioperative neurocognitive disorder", "inflammation" and "systemic", alone and in combination. All articles identified were English-language, full-text papers. The ones cited in the review are those that make a substantial contribution to the knowledge about systemic inflammation and PNDs. The aim of this review is to bring together the latest evidence for the understanding of how perioperative systemic inflammation mediates neuroinflammation and brain injury, how the inflammation is regulated and how we can translate these findings into prevention and/or treatment for PND.
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Affiliation(s)
- Shilin Jia
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Hui Yang
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Fang Huang
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Wenguo Fan
- Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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23
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Wang F, Hao X, Zhu Y. Effects of perioperative intravenous glucocorticoids on perioperative neurocognitive disorders in adults after surgery: A PRISMA-compliant meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34708. [PMID: 37653739 PMCID: PMC10470771 DOI: 10.1097/md.0000000000034708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) have shown uncertain clinical benefits from perioperative intravenous glucocorticoids for perioperative neurocognitive disorders (PND). Thus, this meta-analysis was performed to evaluate whether perioperative intravenous glucocorticoids can decrease the occurrence of PND among adults undergoing surgery. METHODS We searched 4 databases (MEDLINE, Embase, CENTRAL and Web of Science) for RCTs that assessed the incidence of PND in adults (aged ≥ 18 years old) after surgery. Two reviewers independently assessed the studies for eligibility, extracted data, and assessed the risk of bias in each study. We assessed the certainty of evidence using GRADEpro software. RESULTS A total of 10 studies (N = 14,967) were eligible. Compared with controls, glucocorticoids were not associated with reducing the risk of postoperative cognitive dysfunction (POCD) (risk ratio [RR]: 0.79 95% confidence interval [CI]: 0.41-1.55, P = .50, I2 = 85%), risk of postoperative delirium (POD) (RR: 0.87 95% CI: 0.74-1.03, P = .10, I2 = 36%), the length of stay in intensive care unit (ICU) (mean difference [MD] -0.21 95% CI: -1.20 to 0.79, P = .68, I2 = 84%), 30-day mortality (RR: 0.92 95% CI: 0.59-1.46, P = .73, I2 = 0%), or postoperative atrial fibrillation (RR: 0.94 95% CI: 0.86-1.01, P = .11, I2 = 25%). However, there was significant difference between glucocorticoids and control group in the length of hospital stay (LOS) (MD: -0.39 95% CI: -0.62 to -0.16, P = .001, I2 = 0%), and postoperative infections (RR: 0.65 95% CI: 0.56-0.76, P < .00001, I2 = 0%). CONCLUSIONS Perioperative intravenous glucocorticoids did not reduce the risk of PND in adults after surgery but might be associated with shorter the LOS and lower the incidence of postoperative infections. More, larger, higher-quality RCTs including neurological surgery or hip fracture surgery and different doses of glucocorticoids compared with placebos are needed to explore the intervention effects.
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Affiliation(s)
- Fei Wang
- Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital of Sichuan University; Research Units of Perioperative Stress Assessment and Clinical Decision (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Yihao Zhu
- Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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24
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Evered LA, Scott DA, Sanders R. Volatile versus intravenous anaesthesia and perioperative neurocognitive disorders: anything to see here? Br J Anaesth 2023; 131:191-193. [PMID: 37330310 DOI: 10.1016/j.bja.2023.05.018] [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: 05/13/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023] Open
Abstract
There is a potential differential effect of sevoflurane compared with propofol on postoperative delirium and other perioperative neurocognitive disorders. More generally, there are perhaps differences between volatile and intravenous anaesthetic agents in their possible impact on perioperative neurocognitive disorders. Strengths and limitations of a recent study in this journal and its contribution to our understanding of the impact of anaesthetic technique on perioperative neurocognitive disorders are discussed.
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Affiliation(s)
- Lisbeth A Evered
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - David A Scott
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Robert Sanders
- Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre & Central Clinical School, The University of Sydney, Sydney, NSW, Australia
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25
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Wu Y, Yu C, Gao F. Risk factors for postoperative cognitive dysfunction in elderly patients undergoing surgery for oral malignancies. Perioper Med (Lond) 2023; 12:42. [PMID: 37468994 DOI: 10.1186/s13741-023-00330-2] [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: 05/24/2022] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
We aimed to analyse postoperative cognitive dysfunction (POCD) incidence and risk factors in elderly adults who underwent surgery for oral malignancies. A total of 112 elderly patients (aged ≥ 55 years) were selected for expanded resection of oral malignancy and cervical lymphatic dissection at our institution from December 2020 to December 2021. Participants were cognitively evaluated using the neuropsychological test scale 1 day before and 7 days after surgery to determine whether they had developed POCD. Based on whether POCD occurred 7 days after surgery, patients were classified into the POCD and non-POCD groups. Logistic regression was applied to perioperative factors to analyse the risk factors for POCD onset. Seven days after surgery for oral malignancy, there were 37 (33.1%) POCD morbidities. Multiple factor logistic regression analysis revealed that venerable age (odds ratio [OR] = 1.269, 95% confidence interval [CI] 1.056-1.525, P < 0.05), low education levels (OR = 0.792, 95% CI 0.644-0.974, P < 0.05), hypertension (OR = 4.153, 95% CI 1.335-12.732, P < 0.05), dyssomnia (OR = 1.272, 95% CI 1.001-1.617, P < 0.05), prolonged anaesthesia (OR = 1.009, 95% CI 1.001-1.018, P < 0.05), and intraoperative hypotension (OR = 5.512, 95% CI 1.240-24.506, P < 0.05) increased the POCD risk in elderly patients who underwent surgery for oral malignancies. Venerable age, low knowledge reserve, hypertension, dyssomnia, prolonged anaesthesia, and intraoperative hypotension are independent risk factors for POCD in elderly patients with oral malignancies.
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Affiliation(s)
- Yujia Wu
- Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Feng Gao
- The Sixth People's Hospital of Chongqing, Chongqing, China.
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26
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Ma J, Wang F, Wang J, Wang P, Dou X, Yao S, Lin Y. The Effect of Low-Dose Esketamine on Postoperative Neurocognitive Dysfunction in Elderly Patients Undergoing General Anesthesia for Gastrointestinal Tumors: A Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:1945-1957. [PMID: 37408867 PMCID: PMC10318106 DOI: 10.2147/dddt.s406568] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose This study aims to evaluate the effects of the intraoperative application of low-dose esketamine on postoperative neurocognitive dysfunction (PND) in elderly patients undergoing general anesthesia for gastrointestinal tumors. Methods Sixty-eight elderly patients were randomly allocated to two groups: the esketamine group (group Es) (0.25 mg/kg loading, 0.125mg/kg/h infusion) and the control group (group C) (received normal saline). The primary outcome was the incidence of delayed neurocognitive recovery (DNR). The secondary outcomes were intraoperative blood loss, the total amount of fluid given during surgery, propofol and remifentanil consumption, cardiovascular adverse events, use of vasoactive drugs, operating and anesthesia time, the number of cases of sufentanil remedial analgesia, the incidence of postoperative delirium (POD), the intraoperative hemodynamics, bispectral index (BIS) value at 0, 1, 2 h after operation and numeric rating scale (NRS) pain scores within 3 d after surgery. Results The incidence of DNR in group Es (16.13%) was lower than in group C (38.71%) (P <0.05). The intraoperative remifentanil dosage and the number of cases of dopamine used in group Es were lower than in group C (P <0.05). Compared with group C, DBP was higher at 3 min after intubation, and MAP was lower at 30 min after extubation in group Es (P<0.05). The incidence of hypotension and tachycardia in group Es was lower than in group C (P <0.05). The NRS pain score at 3 d after surgery in group Es was lower than in group C (P <0.05). Conclusion Low-dose esketamine infusion reduced to some extent the incidence of DNR in elderly patients undergoing general anesthesia for gastrointestinal tumors, improved intraoperative hemodynamics and BIS value, decreased the incidence of cardiovascular adverse events and the intraoperative consumption of opioids, and relieved postoperative pain.
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Affiliation(s)
- Jiamin Ma
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 201620, People’s Republic of China
| | - Fuquan Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
| | - Jingxu Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
| | - Pengcheng Wang
- Department of Anesthesiology, Zhumadian Central Hospital, Zhumadian, 463000, People’s Republic of China
| | - Xiaoke Dou
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
| | - Yun Lin
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
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Lee TY, Bae HJ, Kim DW, Min TJ. Conscious Sedation Methods for Blepharoplasty in Day Surgery. J Clin Med 2023; 12:4099. [PMID: 37373795 DOI: 10.3390/jcm12124099] [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: 05/09/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Midazolam and fentanyl, in combination, are the most commonly used medications for conscious sedation in day aesthetic surgeries. Dexmedetomidine is popularly used in the sedation protocol of our hospital due to its reduced respiratory depression. However, its sedation benefits in facial aesthetic surgeries, like blepharoplasty, have not been well-evaluated. We retrospectively compared individuals sedated with midazolam and fentanyl bolus injection (N = 137) and those sedated with dexmedetomidine infusion (N = 113) to determine which is more suitable for blepharoplasty with a mid-cheek lift. The total amount of local anesthetic (p < 0.001), postoperative pain (p = 0.004), ketoprofen administration (p = 0.028), and the number of hypoxia episodes (p < 0.001) and intraoperative hypertension (p = 0.003) were significantly lower in the dexmedetomidine group. Hypoxia severity (p < 0.001) and minor hematoma formation (p = 0.007) were also significantly lower in the dexmedetomidine group. Sedation with dexmedetomidine infusion is associated with less hematoma formation than sedation with midazolam and fentanyl bolus pattern due to hemodynamic stability and analgesic effects. Dexmedetomidine infusion may be a good alternate sedative for lower blepharoplasty.
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Affiliation(s)
- Tae-Yul Lee
- Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
| | - Han-Jin Bae
- Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
| | - Deok-Woo Kim
- Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
| | - Too Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
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28
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Li Y, Qiao Y, Li H, Wang Z, Su E, Du Y, Che L. Mechanism of the Mongolian medicine Eerdun Wurile basic formula in improving postoperative cognitive dysfunction by inhibiting apoptosis through the SIRT1/p53 signaling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2023; 309:116312. [PMID: 36863641 DOI: 10.1016/j.jep.2023.116312] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Mongolian medicine Eerdun Wurile is a commonly used Mongolian in folk medicine used to treat cerebral nervous system diseases such as cerebral hemorrhage, cerebral thrombosis, nerve injury and cognitive function, cardiovascular diseases such as hypertension and coronary heart disease. Eerdun wurile may effect anti-postoperative cognitive function. AIM OF THE STUDY To investigate the molecular mechanism of the Mongolian medicine Eerdun Wurile Basic Formula (EWB) in improving postoperative cognitive dysfunction (POCD) based on Network pharmacology, and to confirm involvement of the SIRT1/p53 signal pathway, one of the key signal pathways, by using the POCD mouse model. MATERIAL AND METHODS Obtain compounds and disease-related targets through TCMSP, TCMID, PubChem, PharmMapper platforms, GeneCards, and OMIM databases, and screen intersection genes; Use Cytoscape software to build a "drug-ingredient-disease-target" network, and the STRING platform for protein interaction analysis.; R software was used to analyze the function of gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment.; AutoDock Vina software for active components and core targets to Perform molecular docking. The POCD mouse model was prepared by intracerebroventricular injection of lipopolysaccharide (LPS), and the morphological changes of hippocampal tissue were observed by hematoxylin-eosin (HE) staining, Western blot, immunofluorescence and TUNEL were used to verify the results of network pharmacological enrichment analysis. RESULTS There were 110 potential targets for improving POCD by EWB, 117 items were enriched by GO, and 113 pathways were enriched by KEGG, among which the SIRT1/p53 signaling pathway was related to the occurrence of POCD. Quercetin, kaempferol, vestitol, β-sitosterol and 7-methoxy-2-methyl isoflavone in EWB can form stable conformations with low binding energy with core target proteins IL-6, CASP3, VEGFA, EGFR and ESR1. Animal experiments showed that compared with the POCD model group, the EWB group could significantly improve the apoptosis in the hippocampus of the mice, and significantly down-regulate the expression of Acetyl-p53 protein (P < 0.05). CONCLUSION EWB can improve POCD with the characteristics of multi-component, multi-target, and multi-pathway synergistic effects. Studies have confirmed that EWB can improve the occurrence of POCD by regulating the expression of genes related to the SIRT1/p53 signal pathway, which provides a new target and basis for the treatment of POCD.
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Affiliation(s)
- Yan Li
- Inner Mongolia Medical University, Hohhot, 010059, China.
| | - Yun Qiao
- Inner Mongolia Medical University, Hohhot, 010059, China.
| | - Huiru Li
- Inner Mongolia Medical University, Hohhot, 010059, China.
| | - Zhe Wang
- Inner Mongolia Medical University, Hohhot, 010059, China.
| | - Enboer Su
- Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
| | - Yiri Du
- Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
| | - Limuge Che
- Medicine Innovation Center for Nationalities, Inner Mongolia Medical University, Hohhot, 010110, China.
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Kuzminskaite V, Kontrimaviciute E, Kauzonas E, Slauzgalvyte I, Bukelyte G, Bruzyte‐Narkiene G, Jatuzis D. Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial. Brain Behav 2023; 13:e3017. [PMID: 37086000 PMCID: PMC10275520 DOI: 10.1002/brb3.3017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.
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Affiliation(s)
- Vilma Kuzminskaite
- Faculty of MedicineClinic of Anesthesiology and Intensive CareInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
- Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Egle Kontrimaviciute
- Faculty of MedicineClinic of Anesthesiology and Intensive CareInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
- Faculty of MedicineVilnius UniversityVilniusLithuania
| | | | | | | | | | - Dalius Jatuzis
- Faculty of MedicineClinic of Neurology and NeurosurgeryInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
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Yu K, Zhang XK, Xiong HC, Liang SS, Lu ZY, Wu YQ, Chen Y, Xiao SJ. Stellate ganglion block alleviates postoperative cognitive dysfunction via inhibiting TLR4/NF-κB signaling pathway. Neurosci Lett 2023; 807:137259. [PMID: 37075883 DOI: 10.1016/j.neulet.2023.137259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
Postoperative cognitive dysfunction (POCD) is common in aged patients after major surgery and is associated with increased risk of long-term morbidity and mortality. However, the underlying mechanism remains largely unknown and the clinical management of POCD is still controversial. Stellate ganglion block (SGB) is a clinical treatment for nerve injuries and circulatory issues. Recent evidence has identified the benefits of SGB in promoting learning and memory. We thus hypothesize that SGB could be effective in improving cognitive function after surgery. In present study, we established POCD model in aged rats via partial liver resection surgery. We found that the development of POCD was associated with the activation of toll-like receptor 4/nuclear factor kapa-B (TLR4/NF-κB) signaling pathway in the microglia in dorsal hippocampus, which induced the production of pro-inflammatory mediators (TNF-α, IL-1β, IL-6) and promoted neuroinflammation. More importantly, we showed evidence that preoperative treatment with SGB could inhibit microglial activation, suppress TLR4/NF-κB-mediated neuroinflammation and effectively attenuate cognitive decline after the surgery. Our study suggested that SGB may serve as a novel treatment to prevent POCD in elderly patients. As SGB is safe procedure widely used in clinic, our findings can be easily translated into clinical practice and benefit more patients.
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Affiliation(s)
- Kun Yu
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Xue-Kang Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Han-Chun Xiong
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Si-Si Liang
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Zi-Yun Lu
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yong-Qiang Wu
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yu Chen
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Su-Jun Xiao
- Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China.
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Li X, Gao Y, Han X, Tang S, Li N, Liu X, Ni X. Maresin1 ameliorates postoperative cognitive dysfunction in aged rats by potentially regulating the NF-κB pathway to inhibit astrocyte activation. Exp Gerontol 2023; 176:112168. [PMID: 37055002 DOI: 10.1016/j.exger.2023.112168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
Postoperative cognitive dysfunction (POCD) is one of the most serious postoperative complications in the elderly population. Perioperative central neuroinflammation is considered to be an important pathological mechanism of POCD, with the activation of astrocytes playing a key role in central neuroinflammation. Maresin1 (MaR1) is a specific pro-resolving mediator synthesized by macrophages in the resolution stage of inflammation, and provides unique anti-inflammatory and pro-resolution effects by limiting excessive neuroinflammation and promoting postoperative recovery. However, the question remains whether MaR1 can have a positive effect on POCD. The objective of this study was to investigate the protective effect of MaR1 on POCD cognitive function in aged rats after splenectomy. Morris water maze test and IntelliCage test showed that splenectomy could cause transient cognitive dysfunction in aged rats; however, the cognitive impairment of rats was significantly mitigated when MaR1 pretreatment was administered. MaR1 significantly alleviated the fluorescence intensity and protein expression of glial fibrillary acidic protein and central nervous system specific protein in the cornu ammonis 1 region of the hippocampus. Simultaneously, the morphology of astrocytes was also severely altered. Further experiments showed that MaR1 inhibited the mRNA and protein expression of several key proinflammatory cytokines-interleukin-1β, interleukin-6, and tumor necrosis factor-α in the hippocampus of aged rats following splenectomy. The molecular mechanism underlying this process was explored by evaluating expression of components of the nuclear factor κB (NF-κB) signaling pathway. MaR1 substantially inhibited the mRNA and protein expression of NF-κB p65 and κB inhibitor kinase β. Collectively, these results suggest that MaR1 ameliorated splenectomy-induced transient cognitive impairment in elderly rats, and this neuroprotective mechanism may occur through regulating the NF-κB pathway to inhibit astrocyte activation.
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Affiliation(s)
- Xiuhua Li
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Yubo Gao
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Xu Han
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Shaling Tang
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Na Li
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Xing Liu
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Xinli Ni
- Department of Anaesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
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Zhang M, Suo Z, Qu Y, Zheng Y, Xu W, Zhang B, Wang Q, Wu L, Li S, Cheng Y, Xiao T, Zheng H, Ni C. Construction and analysis of circular RNA-associated competing endogenous RNA network in the hippocampus of aged mice for the occurrence of postoperative cognitive dysfunction. Front Aging Neurosci 2023; 15:1098510. [PMID: 37051377 PMCID: PMC10084838 DOI: 10.3389/fnagi.2023.1098510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
Circular RNAs are highly stable single-stranded circular RNAs and enriched in the brain. Previous studies showed that circRNAs, as part of competing endogenous RNAs (ceRNAs) network, play an important role in neurodegenerative and psychiatric diseases. However, the mechanism of circRNA-related ceRNA networks in postoperative cognitive dysfunction (POCD) has not been elucidated yet. POCD usually occurs in elderly patients and is characterized by hippocampal dysfunction. Here, aged C57BL/6 mice were subjected to exploratory laparotomy under sevoflurane anesthesia, and this POCD model was verified by Morris water maze test. Whole-transcriptome sequencing was performed on the hippocampus of control group (Con) and surgery group. One hundred and seventy-seven DEcircRNAs, 221 DEmiRNAs and 2,052 DEmRNAs were identified between two groups. A ceRNA network was established with 92 DEcircRNAs having binding sites with 76 DEmiRNAs and 549 target DEmRNAs. In functional enrichment analysis, a pathological pattern of POCD was highlighted in the ceRNA network: Abnormal metabolic process in neural cells, including oxygen metabolism, could promote apoptosis and then affect the synaptic function, which may undermine the neural plasticity and eventually lead to changes in cognitive function and other behavioral patterns. In conclusion, this specific ceRNA network of circRNAs–miRNAs–mRNAs has provided novel insights into the regulatory mechanisms of POCD and revealed potential therapeutic gene targets.
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Affiliation(s)
- Mingzhu Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zizheng Suo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Wang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linxin Wu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaozhong Cheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Xiao
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Hui Zheng,
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cheng Ni,
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Qiao H, Chen J, Huang Y, Pan Y, Lu W, Huang Y, Li W, Shen X. Early Neurocognitive Function With Propofol or Desflurane Anesthesia After Laser Laryngeal Surgery With Low Inspired Oxygen. Laryngoscope 2023; 133:640-646. [PMID: 35791905 DOI: 10.1002/lary.30273] [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: 03/30/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The effects of general anesthetics on cognitive impairment are unclear and complicated. Laser laryngeal surgery (LLS) requires the administration of low levels of oxygen, which may increase the risk of desaturation and brain function impairment. This prospective randomized trial aimed to compare the effects of desflurane and propofol-based general anesthesia on the occurrence of early postoperative cognitive decline in elderly patients undergoing LLS. METHODS Seventy-three patients classified as American Society of Anesthesiologists grade I or II and at least 65 years of age were randomly allocated to receive either desflurane-based (Group D) or propofol-based (Group P) anesthesia during LLS. The standard anesthesia protocol was performed, with a bispectral index between 40 and 60 and a mean arterial pressure within 20% of baseline values. Intraoperative regional oxygen saturation values were recorded. Each patient was assessed using the mini-mental state examination (MMSE) test during the preoperative period (baseline), 30 min after extubation in the postanesthesia care unit, and 1, 3, and 24 h after surgery. RESULTS MMSE scores improved slightly in both groups compared to baseline during the early postoperative period, but these increases were not statistically significant. No significant differences were identified in MMSE scores between groups. Only three patients (9.6%) in group D and one patient (3.1%) in group P developed cognitive impairment (p = 0.583). CONCLUSION Low intraoperative inspired oxygen concentration during short-duration LLS did not reduce early postoperative cognitive function in elderly patients. Desflurane or propofol-based anesthesia had similar effects on early neurocognition after LLS. LEVEL OF EVIDENCE 2 Laryngoscope, 133:640-646, 2023.
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Affiliation(s)
- Hui Qiao
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yanzhe Huang
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yiting Pan
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Weisha Lu
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Youyi Huang
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Hsiao WJ, Chen CY, Kang YN, Hu CJ, Chen CH, Lin PL, Lin YC. Apolipoprotein E4 allele is genetically associated with risk of the short- and medium-term postoperative cognitive dysfunction: A meta-analysis and trial sequential analysis. PLoS One 2023; 18:e0282214. [PMID: 36827351 PMCID: PMC9955600 DOI: 10.1371/journal.pone.0282214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
The aim of systematic review and meta-analysis was to investigate whether APOE4 was associated with postoperative neurologic dysfunction occurrence in short- or medium-term among surgical patients and to study the potential genetic association among these two entities. We searched electronic databases for reserch studies to evaluate the association of APOE4 with postoperative delirium (POD) or short- and medium term postoperative cognitive dysfunction (POCD). Twenty-two trials (16 prospective and six retrospective) with 6734 patients were included. APOE4 alleles was shown significantly associated with POCD within 1 week (odds ratio, OR, 1.89, 95% confidence interval, CI, 1.36 to 2.6278, p < 0.01) in the random-effects model. A significant association was also noted between APOE4 and POCD in medium-term, 1-3 months, after surgery (OR: 1.67, 95% CI: 1.003-2.839, p = 0.049). However, APOE4 was not significantly associated with POCD 1 year after surgery (OR: 0.98, 95% CI: 0.57-1.70, p = 0.9449) and POD (OR: 1.28, 95% CI: 0.85-1.91, p = 0.23). In conclusion, APOE4 alleles was genetically associated with short- and medium-term postoperative neurological dysfunction and future screening or preventive strategies derived is highly potential to improve outcomes.
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Affiliation(s)
- Wei-Jen Hsiao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesia, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesia, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Chaur-Jong Hu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Pei-Lin Lin
- Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Cih Lin
- Department of Anesthesia, Taipei Medical University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- * E-mail:
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Guidelines for Wide-Awake Local Anesthesia Surgery with No Tourniquet in the Office Setting Using Field Preparation Sterility. Plast Reconstr Surg 2023; 151:267e-273e. [PMID: 36696323 DOI: 10.1097/prs.0000000000009850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
SUMMARY Wide-awake local anesthesia surgery with no tourniquet, or WALANT, has become popular in surgery, especially among hand surgeons. With the increasing number of surgeons performing office-based procedures, this article provides guidelines that may be used in the office setting to help transition more traditional hospital operating room-based procedures to the office setting. This article outlines the benefits of performing office-based wide-awake local anesthesia surgery with no tourniquet and provides a step-by-step guide to performing procedures that can be easily incorporated into any hand surgeon's practice successfully and safely.
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Barreto Chang OL, Possin KL, Maze M. Age-Related Perioperative Neurocognitive Disorders: Experimental Models and Druggable Targets. Annu Rev Pharmacol Toxicol 2023; 63:321-340. [PMID: 36100220 DOI: 10.1146/annurev-pharmtox-051921-112525] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the worldwide increase in life span, surgical patients are becoming older and have a greater propensity for postoperative cognitive impairment, either new onset or through deterioration of an existing condition; in both conditions, knowledge of the patient's preoperative cognitive function and postoperative cognitive trajectory is imperative. We describe the clinical utility of a tablet-based technique for rapid assessment of the memory and attentiveness domains required for executive function. The pathogenic mechanisms for perioperative neurocognitive disorders have been investigated in animal models in which excessive and/or prolonged postoperative neuroinflammation has emerged as a likely contender. The cellular and molecular species involved in postoperative neuroinflammation are the putative targets for future therapeutic interventions that are efficacious and do not interfere with the surgical patient's healing process.
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Affiliation(s)
- Odmara L Barreto Chang
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA;
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, and Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA; .,Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA
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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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Shen JL, Hang LY, He F, Xu X, Sun HP. Clinical Effect of Application of Interventional Treatment Models for Improvement of Quality of Postoperative Recovery in Elderly Patients with Total Hip Arthroplasty. Int J Gen Med 2022; 15:8343-8351. [PMID: 36457415 PMCID: PMC9707534 DOI: 10.2147/ijgm.s388209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/19/2022] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE To investigate the application value of the interventional treatment model for improving the recovery of elderly patients after total hip arthroplasty (THA). METHODS A total of 50 patients who received THA were randomly divided into the control group (25 cases) undergoing traditional treatment and the experimental group (25 cases) undergoing intervention of cognition, emotion, environment, education, nutrition, and sleep. The mini-mental state examination (MMSE) score, the incidence and duration of postoperative cognitive dysfunction (POCD), the out-of-bed activity time, hospital stays, and the satisfaction degree of patients were compared between the two groups. RESULTS There was no statistically significant difference in basic information between the two groups. On days 7 and 14 after surgery, the MMSE score of the control group was significantly lower than that of the experimental group (P <0.05). The incidence of POCD in the experimental group was lower and its duration was shorter than in the control group but without statistical significance. Besides, the significantly decreased out-of-bed activity time, the reduced length of hospital stay, and the higher satisfaction degree were observed in the experimental group (P <0.05). CONCLUSION Interventional treatment model could significantly increase the MMSE score, accelerate the recovery of elderly patients after THA, and increase their satisfaction degree.
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Affiliation(s)
- Jia-Li Shen
- Department of Orthopaedic, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Ling-Yan Hang
- Department of Orthopaedic, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Fan He
- Department of Orthopaedic, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Xiao Xu
- Department of Orthopaedic, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Hui-Ping Sun
- Department of Orthopaedic, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
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Zhang D, Shen Y, Chen Z, Guo Y, Gao Z, Huang J, Lu X. Emotion recognition dysfunction after anesthesia and cardiac surgery. Front Psychol 2022; 13:1001493. [PMID: 36467133 PMCID: PMC9709145 DOI: 10.3389/fpsyg.2022.1001493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/24/2022] [Indexed: 09/12/2023] Open
Abstract
Cognitive dysfunction after anesthesia and surgery has long been recognized. Recently, researchers provided empirical evidence for social cognition dysfunction (SCD) after anesthesia and surgery. In the present study, we concentrated on the deficits in emotion recognition, one of the most important clinical perspectives in SCD, in patients who underwent cardiac surgery. Biological motion (BM) was considered as the stimulus of interest, and patients' abilities of BM emotion perception and action perception before and after anesthesia and surgery were examined. In total, 60 adult patients (40-72 years old) completed the BM recognition task, which required them to label the types of actions and emotions of perceived BM. The results showed that while action perception remained intact after cardiac surgery, 18.3% of patients exhibited deficits in emotion perception, further confirming the existence of SCD after anesthesia and surgery.
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Affiliation(s)
- Delin Zhang
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Shen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Zhiyun Chen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Yang Guo
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Zaifeng Gao
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Jian Huang
- Department of Data and Information, The Children’s Hospital Zhejiang University School of Medicine, Hangzhou, China
- Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiqian Lu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Zhang J, Basnet D, Du X, Yang J, Liu J, Wu F, Zhang X, Liu J. Does cognitive frailty predict delayed neurocognitive recovery after noncardiac surgery in frail elderly individuals? Probably not. Front Aging Neurosci 2022; 14:995781. [DOI: 10.3389/fnagi.2022.995781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionDelayed neurocognitive recovery (DNR) is a common post-surgical complication among the elderly. Cognitive frailty (CF) is also an age-related medical syndrome. However, little is known about the association between CF and DNR. Therefore, this study aimed to study whether CF is associated with DNR in elderly patients undergoing elective noncardiac surgery, as well as to explore the potential risk factors for DNR in frail elderly individuals and construct a prediction model.MethodsThis prospective cohort study administered a battery of cognitive and frailty screening instruments for 146 individuals (≥65 years old) scheduled for elective noncardiac surgery. Screening for CF was performed at least one day before surgery, and tests for the presence of DNR were performed seven days after surgery. The association between CF and DNR was investigated. Moreover, the study subjects were randomly divided into a modeling group (70%) and a validation group (30%). Univariate and multivariate logistic regression was performed to analyze the modeling group data and identify the independent risk factors for DNR. The R software was used to construct DNR's nomogram model, verifying the model.ResultsIn total, 138 individuals were eligible. Thirty-three cases were diagnosed with DNR (23.9%). No significant difference in the number of patients with CF was observed between the DNR and non-DNR groups (P > 0.05). Multivariate analysis after adjusting relevant risk factors showed that only the judgment of line orientation (JLOT) test score significantly affected the incidence of DNR. After internal validation of the constructed DNR prediction model, the area under the curve (AUC) of the forecast probability for the modeling population (n = 97) for DNR was 0.801, and the AUC for the validation set (n = 41) was 0.797. The calibration curves of both the modeling and validation groups indicate that the prediction model has good stability.ConclusionCognitive frailty is not an independent risk factor in predicting DNR after noncardiac surgery in frail elderly individuals. The preoperative JLOT score is an independent risk factor for DNR in frail elderly individuals. The prediction model has a good degree of discrimination and calibration, which means that it can individually predict the risk probability of DNR in frail elderly individuals.
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Sun Y, Wang Y, Ye F, Cui V, Lin D, Shi H, Zhang Y, Wu A, Wei C. SIRT1 activation attenuates microglia-mediated synaptic engulfment in postoperative cognitive dysfunction. Front Aging Neurosci 2022; 14:943842. [PMID: 36437988 PMCID: PMC9685341 DOI: 10.3389/fnagi.2022.943842] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a debilitating neurological complication in surgical patients. Current research has focused mainly on microglial activation, but less is known about the resultant neuronal synaptic changes. Recent studies have suggested that Sirtuin-1 (SIRT1) plays a critical role in several different neurological disorders via its involvement in microglial activation. In this study, we evaluate the effects of SIRT1 activation in a POCD mouse model. MATERIALS AND METHODS Exploratory laparotomy was performed in mice aged 12-14 months under sevoflurane anesthesia to establish our animal POCD model. Transcriptional changes in the hippocampus after anesthesia and surgery were evaluated by RNA sequencing. SIRT1 expression was verified by Western Blot. Mice were treated with SIRT1 agonist SRT1720 or vehicle after surgery. Changes in microglia morphology, microglial phagocytosis, presence of dystrophic neurites, and dendritic spine density were evaluated. Cognitive performance was evaluated using the Y maze and Morris water maze (MWM). RESULTS Sirtuin-1 expression levels were downregulated in POCD. Exposure to anesthesia and surgery lead to alteration in microglia morphology, increased synaptic engulfment, dendritic spine loss, and cognitive deficits. These effects were alleviated by SRT1720 administration. CONCLUSION This study suggests an important neuroprotective role for SIRT1 in POCD pathogenesis. Increasing SIRT1 function represents a promising therapeutic strategy for prevention and treatment of POCD.
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Affiliation(s)
- Yi Sun
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuzhu Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fan Ye
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Victoria Cui
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Dandan Lin
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Shi
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- State Key Laboratory of Membrane Biology, College of Life Sciences, Peking University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Changwei Wei
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Abstract
OBJECTIVES Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD). METHODS We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%). CONCLUSIONS There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
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Naito Y, Hiraoka A, Himeno M, Chikazawa G, Arimichi M, Yuguchi S, Yoshitaka H, Sakaguchi T. Clinically Optimal Neuropsychological Tests for Postoperative Cognitive Dysfunction in Heart Valve Surgeries. Circ J 2022; 86:1719-1724. [PMID: 36198576 DOI: 10.1253/circj.cj-22-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is widely recognized and reported, but the lack of a uniform definition makes it difficult to evaluate its clinical impact. The aim of this study is to establish the optimal neuropsychological tests and definition of POCD relevant to clinical outcomes in heart valve surgeries. METHODS AND RESULTS Between June 2015 and December 2019, 315 patients undergoing elective heart valve surgeries (age ≥65 years) were enrolled. The Mini-Mental Status Examination, Montreal Cognitive Assessment (MoCA), and the Trail Making Test A and B were performed to evaluate cognitive function. Clinical endpoints were defined as readmission and death. The postoperative readmission and death rate were 17% and 3% (54/315 and 8/315; follow-up 266-1,889 days). By multivariable Cox hazard analysis, Short Physical Performance Battery (adjusted hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.49-0.98, P=0.001), MoCA change rate (adjusted HR: 0.64, 95% CI: 0.01-1.22, P=0.024), and intensive care unit stay (adjusted HR: 0.55%, 95% CI: 0.99-1.12, P=0.054) were detected as independent risk factors for combined events. The cutoff value was -12% in the change rate of MoCA. CONCLUSIONS MoCA was the only neuropsychological test that predicted the clinical impact on complex events and has the potential to define POCD.
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Affiliation(s)
- Yoshitaka Naito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Manami Himeno
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Masahisa Arimichi
- Department of Clinical Engineering, The Sakakibara Heart Institute of Okayama
| | - Satoshi Yuguchi
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
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Zhang Q, Li Y, Wang X, Yin C, Zhou Q, Guo J, Zhao J, Xian X, Hou Z, Wang Q. Sevoflurane exposure causes neuronal apoptosis and cognitive dysfunction by inducing ER stress via activation of the inositol 1, 4, 5-trisphosphate receptor. Front Aging Neurosci 2022; 14:990679. [DOI: 10.3389/fnagi.2022.990679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
The role of the inositol 1, 4, 5-trisphosphate receptor (IP3R) in hippocampal neuronal apoptosis and cognitive dysfunction induced by sevoflurane is currently unclear. Therefore, in this study, we investigated the role of the IP3R in endoplasmic reticulum (ER) stress and hippocampal neuronal apoptosis induced by sevoflurane in aged rats and isolated hippocampal neurons using both in vivo and in vitro experiments, including bioinformatics, functional enrichment analysis, gene set enrichment analysis, hematoxylin, and eosin staining, TUNEL assay, flow cytometry, western blot analysis and transmission electron microscopy. Furthermore, behavioral assessment was performed with the Morris water maze test. We identified 232 differentially expressed genes induced by sevoflurane exposure, including 126 upregulated genes and 106 downregulated genes. Sevoflurane exposure caused cognitive impairment and neuronal injury, and increased p-IP3R levels and ER stress. An IP3R inhibitor, 2-APB, suppressed these changes, while an IP3R agonist, FK-506, aggravated these changes. Together, these findings suggest that sevoflurane exposure causes marked cognitive dysfunction in aged rats and neuronal injury in isolated hippocampal neurons by activating the IP3R and inducing cytoplasmic calcium overload, thereby resulting in ER stress and hippocampal neuronal apoptosis.GRAPHICAL ABSTRACT
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Hata T, Shima H, Nitta M, Ueda E, Nishihara M, Uchiyama K, Katsumata T, Neo M. The Relationship Between Duration of General Anesthesia and Postoperative Fall Risk During Hospital Stay in Orthopedic Patients. J Patient Saf 2022; 18:e922-e927. [PMID: 35532998 DOI: 10.1097/pts.0000000000001021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We performed a retrospective observational study to investigate the relationship between general anesthesia duration and postoperative falls of hospitalized patients who underwent orthopedic surgery. METHODS We used electronic medical record data and incident report data from the Osaka Medical and Pharmaceutical University Hospital. The study included 4,042 patients admitted to the Department of Orthopedic Surgery from 2014 to 2018, and the following exclusion criteria were applied: no surgery, less than 18 years of age, and fall between admission and surgery. This study only considered falls that occurred within 21 days of surgery. The multivariate logistic regression model adjusted for patient background was used to determine the risk of falling according to the duration of general anesthesia. RESULTS After exclusions, 3,398 patients were included in the analysis. Among them, 45 patients (1.32%) had fallen, of whom 7 (15.6%) were injured and 2 (4.4%) experienced fractures. Multivariate logistic regression analysis to determine the adjusted odds ratio showed that longer general anesthesia duration was an independent risk factor for postoperative falls. In addition, cardiovascular disease had significantly higher associations with postoperative falls. CONCLUSIONS In the postoperative care of orthopedic patients, the risk of falling should be assessed by considering the duration of general anesthesia in addition to the traditional fall risk factors. Furthermore, falls could be prevented by educating patients and their caregivers about the risk and mobilizing staff to support postoperative patients at a higher risk of falls when they walk in the hospital.
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Onur T, Karaca Ü, Ata F, Sayan HE, Onur A, Yilmaz C, Balkaya AN, Eriş C. Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study. J Card Surg 2022; 37:2552-2563. [PMID: 35678327 DOI: 10.1111/jocs.16661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/09/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In this study, it was aimed to compare various parameters during surgery and postoperative cognitive functions in patients undergoing coronary artery bypass graft (CABG) surgery using different levels of perioperative oxygen. METHODS One hundred patients scheduled for elective CABG surgery were included in the study. The patients were divided into two groups according to arterial oxygen levels during surgery. In the normoxia group (NG) (n = 50), partial arterial oxygen pressure (PaO2 ) was between ≥100 and <180 mmHg with at least 40% fraction of inspired oxygen (FiO2 ) mechanical ventilation (MV), and in the hyperoxia group (HG) (n = 50), PaO2 was ≥180 mmHg with 100% FiO2 MV. Hemodynamic parameters, peripheral oxygen saturation (SpO2 ), regional cerebral oxygen saturation (rSO2 ) measured from bilateral sensors, and blood gas values were recorded at the planned measurement times. Postoperative features (mortality and infection rates, length of stay in the hospital, and intensive care unit) and complications of the patients have been recorded (low cardiac output syndrome, renal failure, delirium). Mini-Mental State Examination (MMSE) test was applied to the patients before and at the 12th, 24th hours; on the first, third, sixth months after surgery. RESULTS Extubation time was found to be shorter in NG (p < .05). Between the groups, rSO2 and mean arterial pressure were found to be significantly lower in HG at the time of T4 measurement (p = .042, p = .038, respectively). MMSE values of the groups at the first, third, and sixth months were found to be significantly higher in NG (p = .017, p = .014, p = .002, respectively). CONCLUSION Hyperoxemia application during CABG may be associated with worse postoperative late-term cognitive functions.
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Affiliation(s)
- Tuğba Onur
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Ümran Karaca
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Filiz Ata
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Halil E Sayan
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Anıl Onur
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Canan Yilmaz
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Ayşe N Balkaya
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Cüneyt Eriş
- Departmant of Cardiovascular Surgery, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Li J, Xie X, Zhang J, Shen P, Zhang Y, Chen C, Si Y, Zou J. Novel Bedside Dynamic Nomograms to Predict the Probability of Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Noncardiac Surgery: A Retrospective Study. Clin Interv Aging 2022; 17:1331-1342. [PMID: 36072308 PMCID: PMC9443815 DOI: 10.2147/cia.s380234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Early and accurate prediction of elderly patients at high risk of postoperative cognitive dysfunction (POCD) after non-cardiac surgery will provide favorable evidence for rational perioperative management and long-term postoperative recovery. This study aimed to develop bedside dynamic nomograms to provide accurately an individualized prediction of the risk of POCD at 6-month postoperatively with patients undergoing non-cardiac surgery and to guide clinical decision-making and postoperative management. Patients and Methods We retrospectively collected patients undergoing surgical treatment at the Nanjing First Hospital between May 2020 and May 2021. We collected the data on preoperative, intraoperative, and postoperative variables. Clinical and laboratory data on admission and intraoperative variables and postoperative variables were used. We measured the performances of the nomograms using sensitivity, specificity of the receiver operating characteristic (ROC), the area under the ROC curves (AUC), the 10-fold cross-validation, and decision curve analysis (DCA). Results POCD was observed in 23 of 415 patients (5.6%) at 6-month postoperatively. The preoperative and postoperative models obtained 91.6% and 94.0% accuracy rates on the data. Compared to the preoperative model, the postoperative model had an area under the receiver characteristic curve (AUC) of 0.973 vs 0.947, corresponding to a specificity of 0.941 vs 0.918 and a sensitivity of 0.913 vs 0.870. The overall performance of the postoperative model was better than the preoperative model. Conclusion In this study, we developed novel bedside dynamic nomograms with reasonable clinical utility that can provide individualized prediction of POCD risk at 6-month postoperatively in elderly patients undergoing non-cardiac surgery at different time points based on patient admission and postoperative data. External validations are needed to ensure their value in predicting POCD in elderly patients.
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Affiliation(s)
- Junlin Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xianhai Xie
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jiayong Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Po Shen
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yuan Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Yanna Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Correspondence: Yanna Si; Jianjun Zou, Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China, Tel +86 13851639332; +86 15380998951, Email ;
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, People’s Republic of China
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Yang X, Huang X, Li M, Jiang Y, Zhang H. Identification of individuals at risk for postoperative cognitive dysfunction (POCD). Ther Adv Neurol Disord 2022; 15:17562864221114356. [PMID: 35992893 PMCID: PMC9386869 DOI: 10.1177/17562864221114356] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is common, occurring in around 10-54% of individuals within first few weeks after surgery. Although the majority of POCD is less commonly persistent later than 3 months following surgery, the condition increases length of stay (LOS), mortality and long-term cognitive decline, raising the need for a broad screening to identify individuals at risk for POCD during the perioperative period. In this narrative review, we summarize preoperative, intraoperative and postoperative risk factors for POCD reported in last 5 years and discuss neuropsychological tools and potential biomarkers and time points for assessment that might be suitable for clinical use. We aim to provide crucial information for developing a strategy of routine screening for POCD, which may assist with better identification of at-risk individuals for early interventions. Very importantly, the utilization of a standardized strategy may also allow higher consistency and comparability across different studies.
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Affiliation(s)
| | | | - Min Li
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yuan Jiang
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, No.278, Baoguang Avenue Middle Section, Xindu District, Chengdu 610599, China
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Ketamine administration ameliorates anesthesia and surgery‑induced cognitive dysfunction via activation of TRPV4 channel opening. Exp Ther Med 2022; 24:478. [PMID: 35761804 PMCID: PMC9214599 DOI: 10.3892/etm.2022.11405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
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