Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Response Following Major ENT Surgery?

Jildenstål, Pether

doi:10.4172/2155-6148.1000220

Cited by 14 publications

(16 citation statements)

References 24 publications

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“…There are also reports suggesting a reduction in early cognitive adverse effects [21] . We found in two earlier studies that DOA monitoring reduced the risk for early cognitive impairment [8,22] . Chan et al.…”

Section: Discussionmentioning

confidence: 61%

Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey

Jildenstål

Rawal

Hällén

et al. 2014

Annals of Medicine &Amp; Surgery

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Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients.The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel.MethodsA web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD.ResultsThe response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals.ConclusionSwedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects.

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Section: Discussionmentioning

confidence: 61%

Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey

Jildenstål

Rawal

Hällén

et al. 2014

Annals of Medicine &Amp; Surgery

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“…Reported co-morbidities included body mass index, age, sex, education, ASA status, surgery type and duration, presence of depression, preoperative cognitive status, preoperative functional assessment, and preoperative medication use (opioids, benzodiazepines). Chan, 34 Radtke, 44 and Sieber 45 included roughly equal proportions of ASA status patients (I-IV), Jildenstal 46 included only ASA I-II, and Whitlock 47 including a majority of ASA IV patients.…”

Section: Resultsmentioning

confidence: 99%

“…52 used a BIS-guided group (BIS 40–60) vs. a control group of end-tidal anesthetic concentration with goal 0.7–1.3 age-adjusted minimum alveolar concentration and found the rate of postoperative delirium was 18.8% in the BIS group and 28.0% in routine care (p=0.058). Jildenstal et al 46 used auditory evoked potentials -guided anesthesia with an interventional goal of auditory evoked potentials index of 15–20 vs. a control group of unmonitored routine care and found the rate of postoperative delirium was 0% in the interventional group vs. 12.5% in the routine care group (p=0.48).…”

Section: Resultsmentioning

confidence: 99%

Processed Electroencephalogram Monitoring and Postoperative Delirium

et al. 2018

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What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. Methods A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs. Results Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76). Conclusions Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.

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“…Typically, a battery of tests is composed of a comprehensive assessment of the cognitive status, including memory, attention, language, executive function, and motor speed [14] . The Mini-Mental Status Examination (MMSE), a commonly used screening test for dementia with remarkable validity and reliability [16] , is sometimes used to quantify POCD [17] , and an MMSE value below 25 is regarded as POCD [18] . However, comparing cognitive function before operation and adjustment of age or education level is important before determining the POCD.…”

Section: Introductionmentioning

confidence: 99%

“…However, comparing cognitive function before operation and adjustment of age or education level is important before determining the POCD. In addition, the Confusion Assessment Method (CAM) and the Cognitive Failures Questionnaire (CFQ) were used pre- and postoperatively to evaluate the cognitive status [18] . The neuropsychiatric tests that are used in clinical practice are shown in Table 1 [8,15,16,18-21] .…”

Section: Introductionmentioning

confidence: 99%

Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting

Yuan¹,

Lin²

2019

Braz J Cardiovasc Surg

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Postoperative cognitive dysfunction is a common complication following cardiac surgery. The incidence of cognitive dysfunction is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation. Clinical observations demonstrated that pulsatile flow was superior to nonpulsatile flow, and membrane oxygenator was superior to bubble oxygenator in terms of postoperative cognitive status. Nevertheless, cognitive assessments in patients receiving an on-pump and off-pump coronary artery bypass surgery have yielded inconsistent results. The exact mechanisms of postoperative cognitive dysfunction following coronary artery bypass grafting remain uncertain. The dual effects, neuroprotective and neurotoxic, of anesthetics should be thoroughly investigated. The diagnosis should be based on a comprehensive cognitive evaluation with neuropsychiatric tests, cerebral biomarker inspections, and electroencephalographic examination. The management strategies for cognitive dysfunction can be preventive or therapeutic. The preventive strategies of modifying surgical facilities and techniques can be effective for preventing the development of postoperative cognitive dysfunction. Investigational therapies may offer novel strategies of treatments. Anesthetic preconditioning might be helpful for the improvement of this dysfunction.

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Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Response Following Major ENT Surgery?

Cited by 14 publications

References 24 publications

Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey

Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey

Processed Electroencephalogram Monitoring and Postoperative Delirium

Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting

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