Disfunção cognitiva pós-operatória: prevalência e fatores associados

Boos, Gustavo Luchi; Soares, Luiz Fernando Machado; Filho, Getúlio Rodrigues de Oliveira

doi:10.1590/s0034-70942005000500006

Cited by 15 publications

(10 citation statements)

References 17 publications

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“…In most of the studies different methods of neuropsychological testing were implemented, including MMSE [ 29 , 34 , 35 , 36 ], various batteries of popular neuropsychometric tests (for example, Williams-Russo [ 28 ] used a battery of 10 tests, Panda [ 31 ] 7 tests and Moller [ 12 ] 4 different tests) and some self-developed ones (Heyer et al [ 32 ]). Such diversity and lack of standardization impedes the drawing of reliable conclusions and does not allow to formulate recommendations for clinicians for several reasons.…”

Section: Discussionmentioning

confidence: 99%

“…The sole fact that different BP thresholds were applied appears to be a barrier for effective complex analysis. Only 6 out of 13 studies described IOH as either a direct value [ 28 , 34 , 36 , 37 ] or a relative BP drop [ 12 , 29 ]. Additionally, the definitions varied in their established minimal threshold for IOH duration, ranging from the very moment of IOH occurrence to even ≥30 min.…”

Section: Discussionmentioning

confidence: 99%

“…Brazilian researchers, in a study of 55 patients undergoing orthopedic, urologic, general or vascular surgeries in general ( n = 28) or regional ( n = 27) anesthesia, assessed the incidence and risk factors of POCD defined as Mini-Mental State Examination (MMSE) scores below 24/30 or by a decrease of 4 or more points during follow-up evaluations [ 29 ]. The incidence of IOH, defined as systolic BP decrease of more than 30% as compared to baseline values, lasting more than 5 min or needing vasopressor or inotropic support, did not differ between subjects who developed or did not develop POCD ( p = 0.7).…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Krzych

Pluta

Putowski

et al. 2020

JCM

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Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Krzych

Pluta

Putowski

et al. 2020

JCM

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“…This is in agreement with the findings in the present study. The MMSE is widely utilized in research on preoperative cognitive function, and some studies reported that a low preoperative MMSE was a predictor of postoperative delirium 2 , 6 , 29) . Although the MMSE is a convenient and easy method to assess a patient's cognitive function, repeated MMSEs over short time intervals are not recommended because of the learning effect 8 , 34) .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Delirium after Spine Surgery in Elderly Patients

Seo

Park

Lee

et al. 2014

J Korean Neurosurg Soc

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ObjectivePostoperative delirium is a common complication in the elderly after surgery but few papers have reported after spinal surgery. We analyzed various risk factors for postoperative delirium after spine surgery.MethodsBetween May 2012 and September 2013, 70 patients over 60 years of age were examined. The patients were divided into two groups : Group A with delirium and Group B without delirium. Cognitive function was examined with the Mini-Mental State Examination-Korea (MMSE-K), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Information was also obtained on the patients' education level, underlying diseases, duration of hospital stay and laboratory findings. Intraoperative assessment included Bispectral index (BIS), type of surgery or anesthesia, blood pressure, fluid balance, estimated blood loss and duration of surgery.ResultsPostoperative delirium developed in 17 patients. The preoperative scores for the MMSE, CDR, and GDS in Group A were 19.1±5.4, 0.9±0.6, and 3.3±1.1. These were significantly lower than those of Group B (25.6±3.4, 0.5±0.2, and 2.1±0.7) (p<0.05). BIS was lower in Group A (30.2±6.8 compared to 35.4±5.6 in group B) (p<0.05). The number of BIS <40 were 5.1±3.1 times in Group A, 2.5±2.2 times in Group B (p<0.01). In addition, longer operation time and longer hospital stay were risk factors.ConclusionPrecise analysis of risk factors for postoperative delirium seems to be more important in spinal surgery because the surgery is not usually expected to have an effect on brain function. Although no risk factors specific to spinal surgery were identified, the BIS may represent a valuable new intraoperative predictor of the risk of delirium.

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“…The other three studies determined the incidence of POCD using MMSE scale. POCD was defined if the difference between post- and preoperative MMSE score was equal or larger than the standard deviation of preoperative MMSE scores [30]. …”

Section: Resultsmentioning

confidence: 99%

Effect of Ulinastatin in the Treatment of Postperative Cognitive Dysfunction: Review of Current Literature

Huang

Zhang

et al. 2016

BioMed Research International

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Background. Ulinastatin, identified as a urinary trypsin inhibitor, has been widely used in patients with inflammatory disorders. However, little is known about its effect on postoperative cognitive dysfunction (POCD). The aim of our current work is to review the current body of literature. Methods. A systematic literature search in PubMed and EMBASE was performed to identify randomized controlled trials. Incidence of POCD, MMSE score, and laboratory indicators (IL-6, TNF-α, CRP, and S100β) were selected as outcomes. Results. Five RCTs involving 461 elderly patients that underwent surgical operations were identified. The meta-analysis suggested no statistical difference of incidence of POCD between ulinastatin and control groups on postoperative day 1; but ulinastatin could significantly decrease the incidence of POCD on postoperative day 3 and day 7 when compared with control treatment. Ulinastatin was effective in improving the MMSE score on day 1, day 3, and day 7 after operation. IL-6 and S100β concentrations were lower up to postoperative day 2. The incidences of postoperative complications in ulinastatin groups were lower than control. Conclusion. Ulinastatin administration was effective in treating early POCD (postoperative day 3 and day 7) and reducing IL-6 and S100β concentrations within two days after operations. Studies with larger-scale and rigorous design are urgently needed.

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Disfunção cognitiva pós-operatória: prevalência e fatores associados

Abstract: RESUMO U n i t e r m o s : C O M P L I C A Ç Õ E S : d i s f u n ç ã o c o g n i t i v a pós-operatória SUMMARY

Cited by 15 publications

References 17 publications

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Risk Factors for Delirium after Spine Surgery in Elderly Patients

Effect of Ulinastatin in the Treatment of Postperative Cognitive Dysfunction: Review of Current Literature

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