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

Abstract

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).

Preoperative Serum MicroRNA-155 Expression Independently Predicts Postoperative Cognitive Dysfunction After Laparoscopic Surgery for Colon Cancer

“…Previous studies have revealed that serum CRP and urinary trypsin inhibitor are involved in postoperative cognitive dysfunction, especially in elderly patients [19]. Elevated plasma concentrations of TNF-α, IL-6, and S-100β protein also contributed to the occurrence of POCD as biomarkers of systemic inflammation [20]. Therefore, we chose to measure these cytokines (including CRP, TNF-α, IL-6, urea, and creatinine) in our study as possible predicative factors or confounding factors for POCD according to the results reported by previous studies [21].…”

Propofol inhibits endogenous formyl peptide-induced neutrophil activation and alleviates lung injury

“…Various clinical trials have demonstrated that the antioxidant, anti-inflammatory, and free-radical-scavenging properties of propofol can provide clinical benefits. For examples, the use of propofol has been reported to reduce the incidence of postoperative cognitive dysfunction, maintain an appropriate hemodynamic status, shorten ICU stays, and increase the lung compliance of patients who underwent major surgery or cardio-pulmonary bypass Huang et al, 2011;Landis et al, 2014;Qiao et al, 2015;Sayed et al, 2015). Nevertheless, the detailed molecular mechanism that governs these protective effects of propofol is still incompletely understood.…”

Intercellular adhesion molecule-1 and S-100β in sevoflurane combined with epidural anesthesia for radical resection of lung cancer

“…It was basically consistent with our research results. The results of Qiao et al (23) showed that the concentration of S-100β increased after sevoflurane anesthesia alone, while this research showed that the concentration gradually decreased. we speculated that the reason was that the operation combined with epidural puncture anesthesia reduced the stress response of patients and the cognitive dysfunction.…”