Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

Xiao, Qiu‐Xia; Liu, Qing; Deng, Rui; Gao, Zhiwei; Zhang, Ying

doi:10.1111/psyg.12516

Cited by 29 publications

(18 citation statements)

References 75 publications

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“…The repeated application of GA must therefore be re-evaluated under this aspect. Potential post-operative cognitive dysfunction (POCD) which is assumed to influence quality of life and may increase mortality, is multi-factorial and just one aspect that needs further consideration in this context [64,65].…”

Section: Limitationsmentioning

confidence: 99%

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

2020

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Background: Life expectancy of people with permanent disabilities has increased. The dental care of these vulnerable patients is one of the greatest challenges for the dentist and the dental team due to limited or non-existent cooperation and the associated lack of health competence. In order to be able to provide safe and acceptable, quality dental treatment without psychological and physical stress for these patients, it is therefore necessary to resort to sedation or general anaesthesia (GA) under medical supervision. The aim of the analysis is to highlight the need for dental treatment performed under GA for people with disabilities and the associated indications and treatment patterns. Methods: Ten-year retrospective analysis of outpatient dental care under GA for people with disabilities. Results: Of all adult patients (n = 221) who attended the GA pre-assessment, 69.7% (n = 154) received dental treatment under GA based on the clinical findings or in cases of suspected pain. Most patients received one GA. A total of 205 dental treatment sessions were performed under GA mostly for conservative (n = 442, 52%) and surgical (n = 389, 45.8%) procedures. Endodontic treatment (n = 19, 2.2%) was rare. The failure rate related to all teeth in need of treatment (n = 850) was 5.1% (n = 43), in most cases due to secondary caries (n = 40; 93.0%). Patients were enrolled in an annual recall for dental examination and prophylaxis without GA. Non-compliant patients for whom oral hygiene was impossible received a periodic GA. Conclusion: There is a high need of people with disabilities for dental treatment under GA. Main indications for treatment under GA are dental complaints, pain or suspected pain. Dental care can be successful if, for the benefit of patients with special needs, all carers cooperate closely. Caregivers have to be trained in nutrition control as well as in oral hygiene. These factors in conjunction help to prevent dental emergencies.

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Section: Limitationsmentioning

confidence: 99%

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

2020

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“…Postoperative cognitive dysfunction (POCD) refers to post-operative mental disorder, anxiety, personality changes, and memory impairment in patients without mental abnormalities before surgery, which is a central nervous system complication after surgery. [ 1 ] It is been found that patients with cardiovascular surgery had a higher incidence of postoperative cognitive impairment. [ 2 , 3 ] With the deepening of the research, it has found that POCD also has a certain incidence in patients with non-cardiovascular surgery.…”

Section: Introductionmentioning

confidence: 99%

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

Fan¹,

Liu²,

Wu³

et al. 2021

Medicine

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Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management. Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. Logistic regression was used to analyze the potential influencing factors. A total of 572 patients with laparoscopic surgery were included. The incidence of POCD was 11.89%. There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO2 during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13–0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery. For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.

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“…In addition, transfusion of old red blood cells (>14 days) frequently occurs in clinical practice, inducing neuroinflammation and the development of PND via cell-free hemoglobin (Zhu et al, 2014;Tan et al, 2015). Surgery-induced cognitive decline may be attributed to the microglial activation, and the latter would result the release of inflammatory factors and neuroendocrine hormone (Terrando et al, 2011;Subramaniyan and Terrando, 2019;Xiao et al, 2020). Therefore, longer duration of operation is associated with a stronger inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

Xia

Yang²,

Wang³

et al. 2022

Front. Aging Neurosci.

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Background and objectivePostoperative neurocognitive dysfunction (PND) occurs in up to 54% of older patients, giving rise to the heavy psychological and economic burdens to patients and society. To date, the development of PND biomarkers remains a challenge. Heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNPA2/B1) is an RNA-binding protein whose prion-like structure is prone to mutation and hence leads to neurodegenerative diseases, but its expression changes in PND remains unclear. Here, we detect the preoperative hnRNPA2/B1 level in patients with PND, and to explore its value in the prediction and diagnosis of PND.MethodsThe study included 161 elderly patients undergoing lumbar decompression and fusion in Nankai University Affinity the Third Central Hospital from September 2021 to July 2022. Neuropsychological and psychometric evaluations were performed before surgery, 1 week and 3 months after surgery to diagnose the occurrence of PND, then the peripheral blood was collected from patients before induction of anesthesia. The concentration in plasma of hnRNPA2/B1 and amyloid-β 42 were determined by enzyme-linked immunosorbent assay. The median fluorescence intensity and mRNA levels of hnRNPA2/B1 in peripheral blood mononuclear cells was detected by indirect intracellular staining flow cytometry and quantitative real-time PCR, respectively.ResultsThe preoperative hnRNPA2/B1 level in patients with PND was higher both in short-time and long-time follow-up. We found significantly higher concentrations of hnRNPA2/B1 in PND at 7 days after surgery (median, 72.26 pg/mL vs. 54.95 pg/mL, p = 0.022) compared with patients without PND, and so as 3 months after surgery (median, 102.93 pg/mL vs. 56.38 pg/mL, p = 0.012). The area under the curve (AUC) was predicted to be 0.686 at 7 days after surgery and 0.735 at 3 months. In addition, when combining several clinical information, the diagnostic efficiency of hnRNPA2/B1 for PND could further increase (AUC, 0.707 at 7 days, 0.808 at 3 months).ConclusionBased on the findings reported here, hnRNPA2/B1 may serve as a new and powerful predictive biomarker to identify elderly patients with PND.

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Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

Cited by 29 publications

References 75 publications

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

Heterogeneous nuclear ribonucleoprotein A2/B1 as a novel biomarker in elderly patients for the prediction of postoperative neurocognitive dysfunction: A prospective nested case-control study

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