Intraoperative warming and post-operative cognitive dysfunction after total knee replacement

Salazar, F.; Doñate, Marta; Boget, Teresa; Bogdanovich, A; Basora, M.; Fàbregas, Neus

doi:10.1111/j.1399-6576.2010.02362.x

Cited by 34 publications

(49 citation statements)

References 32 publications

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“…Individuals older than 60 years had higher risk for POCD after major non-cardiac surgery in a study by Monk et al [11], and we also saw increased risk in a trial enrolling patients who underwent knee replacement under spinal anesthesia [12]. When Price et al [13] analyzed a subgroup of the non-cardiac surgical patients of Monk et al, they were able to identify different types of decline, finding memory impairment in 13.6%, executive function impairment in 8.4%, and a combination of both in 2.9%.…”

Section: Introductionmentioning

confidence: 73%

“…This post-hoc analysis of the patient sample of a previously conducted clinical trial [12], was approved by the Ethics Committee of Hospital Clinic, Barcelona, Spain, on 22 June 2005 (Ref. 2569).…”

Section: Methodsmentioning

confidence: 99%

“…These scores were calculated for each neuropsychological assessment by first computing the difference from baseline to three months for each subject, then computing the mean and SD of the change scores for a control group (55 controls, as described previously [12]), and finally standardizing the change score for the study patients by subtracting the control group’s mean and dividing the result by the control group’s SD. In this way, the scores of the controls were used to adjust for any learning effect in the study patients in the surgical group.…”

Section: Methodsmentioning

confidence: 99%

“…When Price et al [13] analyzed a subgroup of the non-cardiac surgical patients of Monk et al, they were able to identify different types of decline, finding memory impairment in 13.6%, executive function impairment in 8.4%, and a combination of both in 2.9%. Since we had information available on both rSO 2 trends and specific types of decline for patients in our earlier study [12], we hypothesized that a post-hoc analysis of the data might confirm the findings of Price et al and also allow us to explore a possible relationship between type of cognitive decline and either right-brain or left-brain desaturation. Our psychological assessments encompassed memory, visual-motor coordination and executive function (VM-EF) as well as subjective psychological complaints of memory loss, inability to concentrate, anxiety, and depression.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

et al. 2014

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BackgroundBilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function.MethodsObservational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms.ResultsWe observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).ConclusionsDetection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.

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Section: Introductionmentioning

confidence: 73%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

et al. 2014

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“…Die neuroprotektiven Effekte einer Hypothermie sind ausführlich beschrieben, jedoch auch die negativen Effekte auf das Herz-Kreislauf-System und die Gerinnung. Entscheidend ist vielmehr, v. a. hypertherme Phasen sowohl intra- [57] als auch postoperativ [20] zu vermeiden.…”

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Postoperative kognitive Dysfunktion

2012

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Postoperative cognitive dysfunction (POCD) presents as a long-lasting decline in cognitive function after a surgical procedure, predominantly occurring in elderly patients. The causes are most likely multifactorial with the exact mechanisms still unknown. Hypotheses of the causes of POCD are based on experimental evidence that anesthetics can impair mechanisms of learning and memory on a neuronal level and might lead to neurodegeneration. Additionally, surgery can result in neuroinflammation which could also underlie POCD. The most important strategy to avoid POCD is to maintain the patient's physiological homeostasis perioperatively. According to the presently available clinical studies recommendations in favor or against certain anesthesiological procedures cannot be given.

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Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults

Madrid

Urrútia

Figuls

et al. 2016

Cochrane Database of Systematic Reviews

149

140

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Intraoperative warming and post-operative cognitive dysfunction after total knee replacement

Abstract: Perioperative warming was associated with a higher incidence of cognitive dysfunction at 4 days after total knee replacement in patients >65 years of age.

Cited by 34 publications

References 32 publications

Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

Postoperative kognitive Dysfunktion

Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults

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