Dysfonctions cognitives postopératoires : stratégie de prévention, de dépistage et de prise en charge

Laalou, Fatem-Zohra; Jochum, Denis; Pain, Laure

doi:10.1016/j.annfar.2011.08.009

Cited by 12 publications

(5 citation statements)

References 28 publications

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“…Postoperative cognitive dysfunction may be manifest as impairment of working memory, long-term memory, information processing, attention or cognitive flexibility [ 10 ], adversely affecting quality of life, social independence and mortality [ 11 ]. It may persist for weeks or months, and may not resolve at all in a small proportion of those affected [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation

et al. 2015

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BackgroundElderly patients are reportedly at higher risk of postoperative cognitive dysfunction (POCD) after inhalational anesthesia with sevoflurane. We hypothesized that the incidence of POCD would be higher in elderly patients undergoing major surgery under inhalational rather than intravenous anesthesia. We also measured plasma S-100β protein concentration as a biomarker of central nervous system injury, and plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations to judge the contribution of systemic inflammation to POCD.MethodsNinety patients aged 65–75 years scheduled for resection of an esophageal carcinoma were randomly assigned to one of three groups (n = 30) as follows: a group receiving sevoflurane anesthesia (Group S); a group receiving preoperative methylprednisolone before sevoflurane anesthesia (Group S + MP); and a control group maintained with intravenous propofol (Group C). The mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to measure patients’ cognitive function the day before surgery, and on the first, third and seventh postoperative days. The plasma concentrations of TNF-α, IL-6 and S-100β protein were measured 10 min before anesthesia, and on the first, third and seventh postoperative days.ResultsThere were no significant differences in the demographic or clinical characteristics, or perioperative hemodynamic status, of the three groups. The MMSE and MoCA scores were significantly lower in Group S than in the propofol control (Group C) and Group S + MP on the first, third and seventh postoperative days (P <0.05). Throughout the first postoperative week the plasma concentrations of TNF-α, IL-6, and S-100β protein were significantly elevated in Group S compared with Group C (P <0.05), but were significantly lower in Group S + MP than Group S (P <0.05).ConclusionsThe incidence of POCD was higher in elderly patients undergoing major surgery under inhalational anesthesia with sevoflurane than those maintained on intravenous propofol, and lower in elderly patients pro-treating with methylprednisolone. Furthermore, we found elevated plasma concentrations of S-100β protein, TNF-α and IL-6 in those receiving sevoflurane anesthesia.Trial registrationChiCTR-IOR-15007007 (02-09-2015).

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Section: Discussionmentioning

confidence: 99%

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation

et al. 2015

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“…[2,3] Age, severity of surgery, duration of anesthesia, the stress response, inflammatory and postoperative pain are the risk of POCD, but the pathophysiology and etiology of POCD are relatively unknown. [4–6]…”

Section: Introductionmentioning

confidence: 99%

Effect of parecoxib in the treatment of postoperative cognitive dysfunction

Huang

Cai

et al. 2019

Medicine

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Background:Parecoxib is a selective cyclooxygenase (COX)-2 inhibitor widely used as an analgesia technique in perioperative period for its potent anti-inflammatory and analgesic effects. However, litter is known about its effect on postoperative cognitive dysfunction (POCD). The purpose of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of parecoxib in the treatment of postoperative cognitive dysfunction.Methods:We searched PubMed, Cochrane Library and Embase databases for relevant studies up to October 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows.Results:Four RCTs with 904 patients that underwent surgical operations were included. The meta-analysis demonstrated parecoxib could significantly decrease the incidence of POCD on postoperative day 1, day 3, day 5, and day 7 when compared with control treatment; IL-6 and S100β concentrations were lower up to postoperative day 2. The consumption of morphine, fentanyl and tramadol in parecoxib groups were lower than control groups.Conclusion:Our meta-analysis suggested that the administration of Parecoxib was effective in treating early POCD within 7 days and reducing IL-6 and S100β concentrations within 2 days after operations. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.

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“…An earlier study conducted by Laalou et al showed that the incidence of POCD was related to the patient’s age and time of observation, with an incidence of 23–29% in patients aged 60–69 years and >70 years in the first week and 14% in those aged >70 years in the third month postoperative. 18 Baktiar et al reported that 31 patients who underwent open-heart surgery had 31 patients with POCD and 24 non-POCD. It has been proved that in POCD patients aged 55.4 ± 11.7 and non-POCD patients 50.9 ± 13.6, neuronal damage in elderly patients tends to cause neurological manifestations in the form of cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG

Nurcahyo

Hadisaputro

Muttaqin

et al. 2022

VHRM

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Introduction On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery. Methods This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software. Results The mean age of patients in both groups was 60 years and was dominated by males (>85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs −1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%. Conclusion POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.

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Dysfonctions cognitives postopératoires : stratégie de prévention, de dépistage et de prise en charge

Cited by 12 publications

References 28 publications

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation

Effect of parecoxib in the treatment of postoperative cognitive dysfunction

Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG

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