Cognitive Effects After Epidural vs General Anesthesia in Older Adults

Williams-Russo, Pamela; Sharrock, Nigel E.; Mattis, Steven; Szatrowski, Ted P.; Charlson, Mary E.

doi:10.1001/jama.1995.03530010058035

Cited by 325 publications

(84 citation statements)

References 37 publications

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“…44 Therefore, it remains to be determined whether the volatile anesthetics (e.g., isoflurane) that have been shown to induce apoptosis, Aβ accumulation, and tau phosphorylation can lead to learning and memory impairment in the same rodent model of surgery vs no surgery. Given that surgery without general anesthesia can also cause POCD in humans, 45,46 it is important to determine the effects of surgery without general anesthesia on the cognitive changes.…”

Section: Evidence For Anesthesia-mediated Neurodegenerationmentioning

confidence: 99%

Brief review: Anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease

Bittner

Yue

Xie

2010

Can J Anesth/J Can Anesth

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Purpose Postoperative cognitive decline in the elderly has emerged as a major health concern. In addition, there is a growing interest in the potential relationship between general anesthetic exposure and the onset and progression of Alzheimer’s disease (AD). The available evidence of a possible association between anesthesia, surgery, and long-term cognitive effects, including AD, deserves consideration. In this review, we summarize the evidence for anesthesia-induced neurotoxicity in the elderly, while highlighting the limitations of existing data, and we put the literature into perspective for the clinician. Principal findings A growing body of evidence suggests that general anesthetics may be neurotoxic to both young and aging brains. Much of the evidence originates from in vitro and in vivo studies with cells, rodents, and nonhuman primates. Despite the animal data suggesting a relationship between anesthesia and neurotoxicity in the elderly, a definitive link remains elusive in humans. Conclusions The possible relation between anesthetic neurotoxicity, postoperative cognitive dysfunction, and AD remains elusive. It remains unclear whether postoperative cognitive decline in the elderly is related more to perioperative stress and related medical co-morbidities.

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Section: Evidence For Anesthesia-mediated Neurodegenerationmentioning

confidence: 99%

Brief review: Anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease

Bittner

Yue

Xie

2010

Can J Anesth/J Can Anesth

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“…An international multicenter trial has reported that POCD occurs in 25.8%of patients 1 week and in 9.9%of patients 3 months after noncardiac surgery in patients with the age of more than 60 years old [4], which is associated with impaired daily functioning and increased morbidity and mortality [1–4]. Despite no difference was reported regarding the incidence of POCD in patients receiving general anesthesia or regional anesthesia in recent studies [5, 6], exposure to general anesthesia is still considered to be a remarkable contributor to POCD [7]. Consistently, isoflurane exposure has been reported to induce neurotoxicity associated with learning/memory impairments in neonatal [8], young [9], adult [10], and aged [11] rodents.…”

Section: Introductionmentioning

confidence: 99%

Epigenetic Enhancement of Brain-Derived Neurotrophic Factor Signaling Pathway Improves Cognitive Impairments Induced by Isoflurane Exposure in Aged Rats

Dong

Jia

et al. 2014

Mol Neurobiol

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Isoflurane-induced cognitive impairments are well documented in animal models; yet, the molecular mechanisms remain largely to be determined. In the present study, 22-month-old male Sprague-Dawley rats received 2 h of 1.5 % isoflurane or 100 % oxygen daily for 3 consecutive days. For the intervention study, the rats were intraperitoneally injected with 1.2 g/kg sodium butyrate 2 h before isoflurane exposure. Our data showed that repeated isoflurane exposure significantly decreased the freezing time to context and the freezing time to tone in the fear conditioning test, which was associated with upregulated histone deacetylase 2, reduced histone acetylation, and increased inflammation and apoptosis in the hippocampus, and impairments of brain-derived neurotrophic factor (BDNF)-tyrosine kinase receptor B (TrkB) and the downstream signaling pathway phospho-calmodulin-dependent protein kinase and phospho-cAMP response element-binding protein. These results suggest that isoflurane-induced cognitive impairments are associated with the declines in chromatin histone acetylation and the resulting downregulation of BDNF-TrkB signaling pathway. Moreover, the cognitive impairments and the signaling deficits can be rescued by histone deacetylase inhibitor sodium butyrate. Therefore, epigenetic enhancement of BDNF-TrkB signaling may be a promising strategy for reversing isoflurane-induced cognitive impairments.

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“…Thirty-three patients (15.2%) in our study had dementia; these patients are thought to be more likely to have postoperative complications and higher mortality 15,16. The incidence of dementia was much higher in the GA group (19/72; 26.4%) than in the PNBs group (14/145; 9.7%; P =0.001).…”

Section: Discussionmentioning

confidence: 63%

“…The incidence of dementia was much higher in the GA group (19/72; 26.4%) than in the PNBs group (14/145; 9.7%; P =0.001). “Mental deterioration in the elderly can be avoided by selecting regional rather than general anaesthesia.”16 Due to the importance of body posture during the PNBs procedure, many patients with dementia were not suited for this anesthetic type and had to receive GA in our data. Accordingly, lower mortality at in-hospital and 30-day postoperatively in the PNBs group could not be fully attributed to the anesthetic type.…”

Section: Discussionmentioning

confidence: 99%

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Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

Liu

Wang

Gong

et al. 2014

PPA

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BackgroundGeriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.ObjectivesWe compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty.Materials and methodsThis retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.ResultsSeventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia.ConclusionMortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF.

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Cognitive Effects After Epidural vs General Anesthesia in Older Adults

Cited by 325 publications

References 37 publications

Brief review: Anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease

Brief review: Anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease

Epigenetic Enhancement of Brain-Derived Neurotrophic Factor Signaling Pathway Improves Cognitive Impairments Induced by Isoflurane Exposure in Aged Rats

Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

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