Postoperative cognitive dysfunction in clinical practice

Brodier, E A; Cibelli, Mario

doi:10.1016/j.bjae.2020.10.004

Cited by 38 publications

(30 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A systematic review analyzing seven studies and 1031 patients described a short-term benefit of regional anesthesia on POCD, in the first 3 days after surgery. However, no long-term benefits were mentioned [ 65 ]. Moreover, a randomized study by Rasmussen et al found that regional anesthesia may decrease POCD incidence in the early postoperative period, but no difference was reported at 3 months [ 66 ].…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

“…Moreover, it may be detrimental as it may increase the incidence of hallucinations in the postoperative period [ 81 ]. Results of single bolus administration are inconsistent; therefore, infusion regimens may be a potential subject for studies in an attempt to evaluate ketamine’s neuroprotective effects [ 65 ].…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

“…For better control of anesthesia depth, various non-invasive monitoring techniques might be used, that could affect the POCD rates in cirrhotic patients [ 1 ]. Recently, EEG-based (i.e., BIS ® ), multiparametric-integrated algorithm-based (i.e., NOL ® ), or regional cerebral oxygenation monitoring evaluate the amplitude of hypnosis or nociception during anesthesia, optimizing the need for anesthetics [ 65 ].…”

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

See 2 more Smart Citations

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

et al. 2023

View full text Add to dashboard Cite

Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. The purpose of this review is to summarize the current knowledge regarding the effectiveness of perioperative therapeutic strategies in terms of cognitive dysfunction reduction. Data Collection: Using medical search engines such as PubMed, Google Scholar, and Cochrane library, we analyzed articles on topics such as: POCD, perioperative management in patients with cirrhosis, hepatic encephalopathy, general anesthesia in patients with liver cirrhosis, depth of anesthesia, virtual reality in perioperative settings. We included 115 relevant original articles, reviews and meta-analyses, and other article types such as case reports, guidelines, editorials, and medical books. Results: According to the reviewed literature, the predictive capacity of the common clinical tools used to quantify cognitive dysfunction in cirrhotic settings is reduced in perioperative settings; however, novel neuropsychological tools could manage to better identify the subclinical forms of perioperative cognitive impairments in cirrhotic patients. Moreover, patients with preoperative hepatic encephalopathy could benefit from specific preventive strategies aimed to reduce the risk of further neurocognitive deterioration. Intraoperatively, the adequate monitoring of the anesthesia depth, appropriate anesthetics use, and an opioid-sparing technique have shown favorable results in terms of POCD. Early recovery after surgery (ERAS) protocols should be implemented in the postoperative setting. Other pharmacological strategies provided conflicting results in reducing POCD in cirrhotic patients. Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients.

show abstract

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

Section: Perioperative Cognitive Dysfunction Management In Cirrhotic ...mentioning

confidence: 99%

See 1 more Smart Citation

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Postoperative cognitive dysfunction (POCD), which is defined as a decline in cognitive function after the surgery, is a common postoperative cognitive disorder in patients following surgeries with general anesthesia, particularly in the elderly population (Belrose & Noppens, 2019 ; Brodier & Cibelli, 2021 ; Urits et al., 2019 ). Previous studies showed that the incidence of POCD varied between 20% and 40% in people aged 60 years or older (Lin et al., 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of dexmedetomidine on postoperative cognitive dysfunction in the elderly: A meta‐analysis of randomized controlled trials

Kang

Fan

et al. 2022

Brain and Behavior

View full text Add to dashboard Cite

Introduction Dexmedetomidine (Dex) is suggested to be neuroprotective. However, influence of Dex on postoperative cognitive dysfunction (POCD) in the elderly remains unknown. Methods We performed a meta‐analysis of randomized controlled trials (RCTs) to evaluate the effect of Dex on POCD. Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random‐effect model was used to pool the results. Results Fourteen RCTs including 1626 adults of 60 years or older who received surgery with general anesthesia were included. Because methodologically diverse scales were used for POCD, eight RCTs with POCD diagnosed with Mini‐Mental State Examination (MMSE) were included in the meta‐analysis, while the remaining six RCTs with POCD diagnosed with other scales were qualitative synthesized. Pooled results of RCTs with MMSE showed that Dex significantly reduced the incidence of POCD (risk ratio: 0.47, 95% confidence interval: 0.37–0.60, p < 0.001) with no significant heterogeneity (I2 = 0%) or publication bias (p for Egger's regression test = 0.579). For the remaining six RCTs with POCD diagnosed with other scales, three of them showed that Dex was associated with a significantly lower incidence of POCD, while the other three RCTs did not show a significant difference. Conclusions Dex is associated with a reduced risk of POCD in elderly patients receiving surgeries with general anesthesia, and the results were mainly obtained in studies with POCD diagnosed with MMSE. Based on these findings, Dex may be considered as a preventative measure for POCD in elderly patients.

show abstract

“…To date, the incidence of POCD in cardiac surgery is as high as 71% [4]. The incidence of POCD in elderly patients one week after noncardiac surgery increased from 26% [5] to 30% [6]. Trauma caused by surgery will cause tissue damage, activate the peripheral immune system, lead to the release of inflammatory mediators, induce cognitive impairment, and bring much pressure to anesthesiologists and surgeons.…”

Section: Introductionmentioning

confidence: 99%

Research Progress on the Effect of IL-17 on Postoperative Cognitive Dysfunction

2022

JCMP

View full text Add to dashboard Cite

Postoperative cognitive dysfunction (POCD), which is used to describe the decline of learning and memory after the operation, has been known for decades, but this issue has been controversial because of the differences in age, education level and assessment tools. With the aging of the population and the increase in the amount of anesthetic surgery, the incidence of POCD also increases. At present, the cause of the above phenomenon is not clear. Recent studies have found that inhibition of the inflammatory CD4 + T-cell lineage and T helper 17 (Th17) cells can greatly improve POCD. It is worth noting that IL-17 is a new type of inflammatory cytokine secreted by Th17 cells, which may play a role in the development of POCD. Therefore, based on the above analysis, this article reviews the role and clinical value of IL-17 in POCD.

show abstract

Postoperative cognitive dysfunction in clinical practice

Cited by 38 publications

References 29 publications

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

Influence of dexmedetomidine on postoperative cognitive dysfunction in the elderly: A meta‐analysis of randomized controlled trials

Research Progress on the Effect of IL-17 on Postoperative Cognitive Dysfunction

Contact Info

Product

Resources

About