The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery

Kurnaz, Pınar; Sungur, Zerrin; Çamcı, Emre; Sivrikoz, Nükhet; Orhun, Günseli; Şentürk, Mert; Sayın, Ömer Ali; Tirelı, Emin; Gürvıt, Hakan

doi:10.1016/j.bjane.2016.01.001

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…[22] In our previous studies, we also used the second definition in cardiac surgery patients. [34,35] The third point may be that our test battery cannot be considered as a conventional "comprehensive" test battery since it was specially designed to be practical for use by an anesthesiologist (G.O), who was supervised by a behavioral neurologist (H.G). However, we think that this was not a major flaw, as incidence rates of POCD were similar to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Orhun

Sungur

Koltka

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention. METHODS:Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesia was combined with GA. Patients' cognitive function was assessed before and one week after surgery using a neuropsychological test battery. POCD was defined as a drop of one standard deviation from baseline on two or more tests. RESULTS:A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups, except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p<0.001, respectively). The incidence of POCD was comparable between groups (26% in GI and 24% in GII). Memory performance, visuospatial functions, and language skills tests were significantly higher in GII compared to GI. CONCLUSION:General anesthesia and epidural analgesia combined with general anesthesia resulted in similar POCD in elderly patients undergoing abdominal surgery. However, in combined anesthesia group memory, language skills and visuospatial functions appeared to be better preserved. Effective pain control might contribute to preventing cognitive decline in some domains.

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Section: Discussionmentioning

confidence: 99%

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Orhun

Sungur

Koltka

et al. 2019

Ulus Travma Acil Cerrahi Derg

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“…Preventive measures to improve neurological outcome implies maintenance of pressures, assessment of adequate perfusion or management of metabolic state. 9 , 10 , 11 , 12 , 17 , 18 Evaluation of cerebral perfusion with cerebral oximetry is easy with fast signal response time and allows early recognition of brain perfusion abnormalities. 19 Relationship between neurological complications and cerebral oximetry has been investigated after cardiac surgery with inconsistent results.…”

Section: Discussionmentioning

confidence: 99%

Effects of cerebral oxygen changes during coronary bypass surgery on postoperative cognitive dysfunction in elderly patients: a pilot study

Şahan

Sungur

Çamcı

et al. 2018

Brazilian Journal of Anesthesiology (English Edition)

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“…Additionally, they found that persistent POCD was observed in 5 patients (25%) in the tight glucose control group, while no POCD was observed in the liberal control group at 3 months ( p = 0.047). This suggests tight intra-operative glycaemic control may prevent persistent cognitive impairment following cardiac surgery ( 21 ). However, future studies should aim to use standardised interventions and definitions of tight glycaemic control to establish the most effective method of peri-operative glycaemic control following cardiac surgery.…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

“…The preoperative risk factors for POCD include advanced age ( 11 – 13 ), lower educational levels ( 12 ), pre-existing cognitive impairment ( 12 , 14 ), APOE4 genotype carriers ( 15 ), depression ( 13 ), and diabetes ( 13 , 16 ). The intraoperative risk factors include the surgical approach, use of cardiopulmonary bypass (CPB) ( 17 ), duration of surgery ( 13 , 18 ) and anaesthesia ( 12 , 13 , 19 ), arterial pressure management ( 20 ), glycaemic management ( 21 ) and intraoperative haemoglobin concentration ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery

Cited by 7 publications

References 30 publications

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Comparison of epidural analgesia combined to general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Effects of cerebral oxygen changes during coronary bypass surgery on postoperative cognitive dysfunction in elderly patients: a pilot study

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

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