A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Price, Catherine C.; Tanner, Jared J.; Schmalfuss, Ilona M.; Garvan, Cynthia Wilson; Gearen, Peter; Dickey, David M.; Heilman, Kenneth M.; McDonagh, David L.; Libon, David J.; Leonard, Christiana M.; Bowers, Dawn; Monk, Terri G.

doi:10.1097/01.sa.0000450929.24556.63

Cited by 11 publications

(12 citation statements)

References 63 publications

(71 reference statements)

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“…Patient recovery could be expedited. The rate of POCD in the HIBIS group of the current study (3.3%) is much lower than the reported rate in patients receiving noncardiac surgical procedures (25%-44%) (Li, Wen, Zhao, Hang, & Mandell, 2013;Moller et al, 1998;Monk & Price, 2011;Price et al, 2014). Such a difference could be attributed to differences of a variety of factors, including the definition of POCD, surgery type, and patient demographic features.…”

Section: Discussioncontrasting

confidence: 74%

POCD in patients receiving total knee replacement under deep vs light anesthesia: A randomized controlled trial

et al. 2018

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ObjectivesClinical observation, as well as randomized controlled trials, indicated an increasing rate of postoperative cognitive dysfunction (POCD) with increasing depth of general anesthesia. However, the findings are subject to bias due to varying degree of analgesia. In this trial, we compared the rate of POCD between patients receiving light versus high anesthesia while holding analgesia comparable using nerve block.MethodsElderly patients (≧60 years) receiving elective total knee replacement were randomized to receive the surgery under general anesthesia at BIS 40–50 (LOBIS group) or BIS 55–65 (HIBIS group). The femoral nerve and the sciatic nerve were blocked under ultrasonic guidance in all patients before induction. Cognitive performance was assessed with Montreal cognitive assessment (MoCA) at the baseline and 1d, 3d, and 7d after the surgery. POCD was defined by Z score of >1.96 using cross‐reference. The extubation time and recovery time were also compared.ResultsA total of 66 patients were randomized; 60 (n = 30 per group) completed trial as the protocol specified. POCD occurred in six patients (20%) in the LOBIS group vs. in one patient (3.3%) in the HIBIS group (Figure 3, p = .04). In all seven cases, the diagnosis of POCD was based on MoCA assessment on 1d after the surgery. Assessment in 3d and 7d after surgery did not reveal POCD in any case. Extubation time was longer in the LOBIS group (12.16 ± 2.58 vs. 5.77 ± 3.01 min in the HIBIS group (p < .001)). The time of comeback of directional ability was 13.47 ± 3.14 and 6.17 ± 3.23 min in the LOBIS and HIBIS groups, respectively (p < .001).ConclusionsIn elderly patients receiving a total knee replacement, lighter anesthesia could reduce the rate of POCD with complete analgesia during surgery.

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Section: Discussioncontrasting

confidence: 74%

POCD in patients receiving total knee replacement under deep vs light anesthesia: A randomized controlled trial

et al. 2018

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“…A strength of this study is the Successful Aging after Elective Surgery data, 22 which is remarkable for its longitudinal follow-up of more than 500 surgical patients using well-validated delirium measures and a neuropsychologic test battery sensitive to global and domain-specific cognitive change. 60,61 Others have also reported associations between postoperative delirium and postoperative cognitive dysfunction at hospital discharge or 1 month, but not at later follow-up. 9,57,58 Franck et al 54 only found an association between postoperative delirium and postoperative cognitive dysfunction in a subgroup of participants, and concluded that there was no clear evidence that delirium is independently associated with postoperative cognitive dysfunction beyond 1 week after surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction

La¹,

Am²,

R³

et al. 2019

Anesthesiology

217

145

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. Methods This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. Results One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09). Conclusions Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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“…The resulting description of functional connectivity changes constituting a normal peri-anesthetic trajectory in healthy older adults will fill a gap in our current understanding and serve as a baseline for comparison with studies employing fMRI to investigate postoperative cognitive function in surgical patients. [19][20][21][22] To this end, we report presently on analysis of rs-fMRI data for 62 healthy adult subjects. Table 1.…”

Section: Introductionmentioning

confidence: 99%

Resting state functional connectivity in early post-anesthesia recovery is characterized by globally reduced anticorrelations

Nir

Jacob

Huang

et al. 2019

Preprint

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Though a growing body of literature is addressing the possible longer-term cognitive effects of anesthetics, to date no study has delineated the normal trajectory of neural recovery due to anesthesia alone in older adults. We obtained resting state functional magnetic resonance imaging scans on 62 healthy human volunteers between ages forty and eighty before, during, and after sevoflurane (general) anesthesia, in the absence of surgery, as part of a larger study on cognitive function post-anesthesia. Resting state networks expression decreased consistently one hour after emergence from anesthesia. This corresponded to a global reduction in anticorrelated functional connectivity post-anesthesia, seen across individual regions-of-interest. Positively correlated functional connectivity remained constant across peri-anesthetic states. All measures returned to baseline 1 day later, with individual regions-of-interest essentially returning to their pre-anesthesia connectivity levels. These results define normal peri-anesthetic changes in resting state connectivity in healthy older adults.

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A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Cited by 11 publications

References 63 publications

POCD in patients receiving total knee replacement under deep vs light anesthesia: A randomized controlled trial

POCD in patients receiving total knee replacement under deep vs light anesthesia: A randomized controlled trial

Postoperative Delirium and Postoperative Cognitive Dysfunction

Resting state functional connectivity in early post-anesthesia recovery is characterized by globally reduced anticorrelations

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