Postoperative cognitive disorders

Monk, Terri G.; Price, Catherine C.

doi:10.1097/mcc.0b013e328348bece

Cited by 211 publications

(183 citation statements)

References 39 publications

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“…Whether common perioperative neurologic complications such as delirium and postoperative cognitive dysfunction are related to anesthetic neurotoxicity or other factors is similarly unknown. 37 It will be difficult to directly study the neuroprotective or neurotoxic effects of general anesthetics in patients with AIS. However, outcome studies in ischemic stroke populations are needed to define the shortterm and long-term impact of general anesthetics on the nervous system.…”

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confidence: 99%

Anesthesia for endovascular treatment of acute ischemic stroke

et al. 2012

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The initial treatment of patients with acute ischemic stroke (AIS) focuses on rapid recanalization, which often includes the use of endovascular therapies. Endovascular treatment depends upon micronavigation of catheters and devices into the cerebral vasculature, which is easier and safer with a motionless patient. Unfortunately, many stroke patients are unable to communicate and sufficiently cooperate with the procedure. Thus, general anesthesia (GA) with endotracheal intubation provides an attractive means of keeping the patient comfortable and motionless during a procedure that could otherwise be lengthy and uncomfortable. However, several recent retrospective studies have shown an association between GA and poorer outcomes in comparison with conscious sedation for endovascular treatment of AIS, though prospective studies are lacking. The underlying reasons why GA might produce a worse outcome are unknown but may include hemodynamic instability and hypotension, delays in treatment, prolonged intubation with or without neuromuscular blockade, or even neurotoxicity of the anesthetic agent itself. Currently, the choice between GA and conscious sedation should be tailored to the individual patient, on the basis of neurologic deficits, airway and hemodynamic status, and treatment plan. The use of institutional treatment protocols may best support efficient and effective care for AIS patients undergoing endovascular therapy. Important components of such protocols would include parameters to choose anesthetic modality, timeliness of induction, blood pressure goals, minimization of neuromuscular blockade, and planned extubation at the end of the procedure. Neurology ® 2012;79 (Suppl 1):S167-S173

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confidence: 99%

Anesthesia for endovascular treatment of acute ischemic stroke

et al. 2012

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“…Surgical technique can affect the cognitive status of patients, and it was shown that patients with short surgical technique have lower risk to develop POCD compared to patients with long surgical technique and it is due to decreased inflammatory response [4]. In the last years it was seen that the use of anti-inflammatory strategies such as dexmedetomidine before the beginning of anesthesia, may reduce incidence of POCD [20]. Moreover, a normal nutritional status and hydration, a short period of fasting before surgery, physiological day-night rhythm, social contacts, frequent visits by family and friends aftersurgery, and early discharge from hospital are associated with reduced incidence of POCD [4].…”

Section: Resultsmentioning

confidence: 99%

Postoperative Cognitive Dysfunction in Elderly Patients: A Frequent Complication

Cosmo¹,

Sessa²,

Fiorini³

et al. 2015

JACCOA

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also weeks or months after surgery and not always recognized in the early postoperative period because its recognition need the employment of neurological and psychological tests [2]. POCD must be distinguished by delirium that is present early in postoperative period and is characterized by an acute change of attention and thought. It can be diagnosed utilizing confusion assessment method (CAM) [3]. The reported incidence of POCD varies from 7 to 71% at seven-eight postoperative days and 6 to 56% at an interval of 42-84 days [4]. The exact incidence is not known because POCD is not always recognized in the postoperative period since diagnosis requires many sensitive neuropsychological tests and these tests can be difficult to administer in clinical trials in which the sample of the patients may be elevated. Tests are different for the cognitive domain that they study. The working group ISPOCD (International Study of Postoperative Cognitive Dysfunction) has conducted several studies in this field and has also created some recommendations. It was found that in the diagnosis of POCD it should be used a battery of tests to investigate the different domains involved in cognitive functions such as memory, attention, speed motion sensory and flexibility cognitive; moreover, these tests should be sensitive to allow the diagnosis of mild deficits such as those characteristic of POCD. The assessment of cognitive function in the postoperative period is based on the results of pre-and postoperative tests. Often, to correct the "practice effect" that is often present when performing neuropsychological tests repeated over time it is used a control group [5].Moreover, the incidence of POCD varies in the studies examined because there are many risk factors promoting POCD related to patient, to surgery, to anesthesia and the incidence varies according the population studied. With regard to patientrelated factors, the so-called predisposing factors, the last studies mentioned old age and low level of education [6,7], the presence of preoperative cognitive impairment, the chronic use of narcotics and/or benzodiazepines, the number of comorbid conditions, the cerebrovascular and the occurrence of postoperative delirium [8]; role of genetic predisposition is not yet clear as the results available are conflicting. Regarding to surgery related factors, some studies have shown that POCD is more frequent after cardiac surgery than after non-cardiac surgery and the use of cardio-pulmonary bypass (CPB) has been described as a major contributor to the high incidence of POCD in this situation. Moreover, reoperation, infections and postoperative pulmonary complications increase the risk of occurrence of POCD [9].

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“…These conditions frequently occur on the third postoperative day, which may be due to the occurrence of desaturation on the preceding night. 15,22 Additional complications arising from arterial hypoxemia may be decreased tissue oxygenation resulting in an increased risk of infection and delayed wound healing. 18,20 Finally, arterial hypoxemia results in patients attempting to compensate by increasing their respiratory rate and their effort to breathe.…”

Section: Discussionmentioning

confidence: 99%

“…This is a modification of the definition from Lewer et al 6 and Rosenberg et al 14 Demographic data, surgical procedures, site of operation, anesthetic and analgesic management, and intraoperative events were recorded. Possible risk factors for desaturation were the following: elderly 15 …”

Section: Methodsmentioning

confidence: 99%

L’obésité, l’analgésie péridurale et l’incision sous-costale sont des facteurs de risque de désaturation postopératoire

Siriussawakul

Mandee

Thonsontia

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This study was designed to determine the incidence of oxygen desaturation after upper abdominal surgery during the first 48 hr on general surgical wards and also to identify risk factors for oxygen desaturation. Methods This descriptive study was conducted in 206 patients not expected to receive supplemental oxygen postoperatively who were undergoing upper abdominal surgery in a tertiary care university hospital. Desaturation was classified either as constant, i.e., oxygen saturation \ 90% for [ three minutes or \ 85% once or as episodic, i.e., when oxygen saturation is decreased by C 5% below baseline for one to two minutes ten times or more during the night period. Possible risk factors were elderly patients ([ 70 yr), obesity (body mass index [BMI] [ 25 kg.m -2 ), smoking, surgical time [ 180 min, postoperative pain control methods, intraoperative blood loss, and site of incision. Results Of the 206 patients enrolled, 171 were retained for analysis. Desaturation occurred in 65 patients (38%). Forty-eight of these had constant hypoxemia with nadir oxygen saturation values ranging from 71-89%. The remaining 17 patients experienced nocturnal episodic hypoxemia. After multivariate analysis, the three factors that correlated with postoperative desaturation were BMI [ 25 (adjusted odds ratio [OR] 3.06; 95% confidence interval (CI) 1.38-6.79; P = 0.006), subcostal incision (OR 2.68; 95%CI 1.34-5.38; P = 0.005), and neuraxial opioids (OR 2.44; 95%CI 1.21-4.91; P = 0.013). Conclusion Oxygen desaturation is common after upper abdominal surgery, and the risk factors are obesity, a subcostal incision, and neuraxial opioid administration. RésuméObjectif Cette e´tude a e´te´conçue afin de de´terminer l'incidence de de´saturation en oxyge`ne dans les 48 h apre`s une chirurgie abdominale haute aux unite´s de soins de chirurgie ge´ne´rale ainsi que d'identifier les facteurs de risque associe´s à une de´saturation en oxyge`ne. Méthode Cette e´tude descriptive a e´te´mene´e aupre`s de 206 patients pour lesquels de l'oxyge`ne supple´mentaire n'e´tait pas pre´vu apre`s l'ope´ration et qui subissaient une chirurgie abdominale haute dans un hôpital universitaire de soins tertiaires. La de´saturation a e´te´cate´gorise´e en constante, soit une saturation d'oxyge`ne \ 90 % pour [ trois minutes ou \ 85 % une fois, ou e´pisodique quand la saturation d'oxyge`ne a diminue´de C 5 % sous la valeur de base pour une ou deux minutes dix fois ou plus pendant la nuit. This work was presented, in part, as an abstract at the 69 th annual meeting of the Royal College

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Postoperative cognitive disorders

Cited by 211 publications

References 39 publications

Anesthesia for endovascular treatment of acute ischemic stroke

Anesthesia for endovascular treatment of acute ischemic stroke

Postoperative Cognitive Dysfunction in Elderly Patients: A Frequent Complication

L’obésité, l’analgésie péridurale et l’incision sous-costale sont des facteurs de risque de désaturation postopératoire

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