Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

Xu, Yun; Ma, Qianquan; Du, Hongliang; Yang, Chenlong; Lin, Guigao

doi:10.3390/brainsci12101371

Cited by 8 publications

(11 citation statements)

References 136 publications

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“…In our study, delirium was found to occur in 22.01% of postoperative MVD patients. Previous studies on the mechanisms of delirium development have proposed various hypotheses, such as neuroinflammation, neuronal aging, oxidative stress, neurotransmitter deficiency, neuroendocrine, circadian dysregulation, and network disconnection, including a variety of mechanisms, such as neurotransmitter synthesis and functional alterations, which may interact to jointly mediate the various cognitive and behavioral dysfunctions associated with delirium [40][41][42]. Several previous studies have suggested predictive indicators of postoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Postoperative Serum Neuro-Specific Enolase Levels with Postoperative Delirium Occurring after Microvascular Depression Surgery in Older Patients

Guo

Liu

et al. 2022

JVD

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There is a high incidence of postoperative delirium (POD) following microvascular decompression (MVD) surgery. Neuronal survival, differentiation, and neurite regeneration are regulated by neuro-specific enolase (NSE). Therefore, we investigated and assessed whether circulating NSE levels are related to POD after MVD surgery. We recruited a total of 209 patients and 209 age- and gender-matched healthy controls. A retrospective review of electronic medical records was conducted, and serum NSE levels were measured in the serum of patients before and after surgery, as well as the serum of controls. Patients were categorized according to the presence of POD. Postoperative patient serum levels of NSE were significantly higher compared to preoperative levels. Additionally, postoperative serum NSE levels were remarkably higher in POD patients than non-POD patients. In addition, there was no significant correlation between NSE levels and the type and severity of postoperative delirium. Age (OR = 1.153, 95% CI = 1.040–1.277, p = 0.006), the levels of serum NSE (OR = 1.326, 95% CI = 1.177–1.494, p < 0.001), and the levels of serum S100β (OR = 1.006, 95% CI = 1.000–1.012, p = 0.048) were the three independent variables for predicting POD. A significant correlation existed between serum S100β levels and serum NSE levels (t = 2.690, p = 0.008). In terms of area under the precision–recall curve, the discriminatory ability of serum NSE levels (AUC = 0.876, 95% CI = 0.829–0.924, p < 0.0001) was close to that of the serum S100β level (AUC = 0.879, 95% CI = 0.825–0.933, p < 0.0001) and significantly higher than that of age (AUC = 0.813, 95% CI = 0.755–0.871, p < 0.0001). Combining all three features produced a dramatic improvement over individual effects. The NSE level in serum was a stronger indicator of the likelihood of POD after MVD surgery in the older population. The clinical determination of this factor might be useful for distinguishing older patients at risk of POD after MVD surgery on the basis of their clinical findings.

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Section: Discussionmentioning

confidence: 99%

Relationship of Postoperative Serum Neuro-Specific Enolase Levels with Postoperative Delirium Occurring after Microvascular Depression Surgery in Older Patients

Guo

Liu

et al. 2022

JVD

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“…Still, it could be useful to have a screening tool that is both objective and proven (Figure 2) [28]. Reproduced under the terms and conditions of the Creative Commons Attribution (CC BY) license from ref [29].…”

Section: Postoperative Cognitive Change After Hospital Dischargementioning

confidence: 99%

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Lakshminarayanan,

Aboobacker,

Brar

et al. 2024

Cureus

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Perioperative neurocognitive disorders (PNDs) affect a large percentage of people who undergo surgeries that need general anesthesia. There is an increased risk of death and a major disruption to postoperative self-care as a result of this. This study compiles all the relevant materials that the authors have found to investigate postnatal depression and its causes, as well as the methods used to determine the probability and severity of PNDs and how to reduce their risk before surgery. Postnatal depression can have many causes, and this text explores some of them. These include a history of alcohol or opiate use, immunological dysregulation, advanced age, educational background, infections, neurocognitive impairment, and preexisting chronic inflammatory disorders. It also delves into various methods used to gauge the likelihood and severity of postpartum depression. The following assessment tools were covered: the Clock Drawing Test, Domain-Specific Tests, the Mini-Mental State Examination, and the Montreal Cognitive Assessment. In addition to biochemical markers, neuroimaging techniques play an important role in diagnosis. The Frailty Fried assessment, which measures inertia, sluggishness, lack of physical activity, fatigue, and unintentional weight loss, is a key prognostic sign that is highlighted. There is strong evidence that the index, which is derived from these five characteristics, may accurately predict the likelihood of PNDs. Risk mitigation strategies are also covered in this research. Preoperative brain plasticity-based therapies, such as physical exercise and intensive cognitive training, can significantly reduce the incidence and severity of postoperative neurocognitive disorders. A peripheral nerve block, monitoring cerebral oxygen saturation, dexmedetomidine, and a reduction in anesthesia depth are all ways to improve anesthetic procedures. Methods that lower blood pressure should be avoided, the body temperature should be kept down during surgery, or the time without liquids should be lengthened; all of these raise the risk of postoperative nausea and vomiting and make it worse. Potential approaches include a Mediterranean diet, physical activity, cognitive stimulation, smoking cessation, alcohol reduction, avoidance of anticholinergic medications, and non-steroidal anti-inflammatory drug stewardship, although there is no definitive evidence for successful postoperative neurocognitive rehabilitation procedures. More standardized diagnostic criteria, evaluation methods, and PND classification are urgently needed, according to this study. Different cases of PNDs are characterized by different combinations of tests, cutoff values, and methods because there is a broad variety of diagnostic tests used to make the diagnosis. Until now, PNDs and pre-existing neurocognitive disorders have been diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). With an aging population comes an increase in the occurrence and prevalence of PNDs, which calls for a specific way to classify an...

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“… 7 Over the past decades, surgeons and anesthesiologists have devoted great efforts to exploring effective pharmacological interventions of POD, nevertheless, they found antipsychotics, acetylcholinesterase inhibitors, steroids, and statins might cause heightened adverse effects and poorer long-term outcomes. 8 Recently, primary prevention of POD with multicomponent nonpharmacologic approaches such as reorientation, early mobilization, sleep strategies, and hearing and vision adaptations are taken as promising strategies. 9 Therefore, it is a priority to identify high-quality and adequately powered evidence of nonpharmacologic treatment that could be effective and safe to prevent POD.…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Electrical Acupoint Stimulation for Preventing Postoperative Delirium: A Meta-Analysis

Guo¹,

Yan²,

Sun³

et al. 2023

NDT

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Objective This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) for postoperative delirium (POD) in surgical patients. Methods Based on database searches of the Wanfang, China National Knowledge Infrastructure (CNKI), VIP, Chinese Biology Medicine (CBM), PubMed, Cochrane Library, and Web of Science, relevant RCTs published before December 30, 2022, were extracted. Outcome indicators included the incidence of POD, changes in Confusion Assessment Method (CAM) scores, Visual Analogue Scale (VAS) scores, and the intraoperative consumption of anesthetics. Data were pooled and analyzed by Review Manager 5.3, and publication bias detection was conducted using Stata 17.0. Results A meta-analysis containing 715 experimental and 717 control participants from 12 RCTs was performed. The overall results showed that TEAS had obvious superiority with a lower incidence of POD on any day during the postoperative 1 week. In subgroup analyses, the CAM scores on the third postoperative day were significantly lower in the TEAS group than in the control group (MD = −0.52, 95% CI: −1.02 to −0.03, P = 0.04), the VAS scores on the first postoperative day were significantly lower in the TEAS group than in the control group (MD = −0.19, 95% CI: −0.36 to −0.02, P = 0.03), the consumption of propofol and remifentanil were both significantly lower in the TEAS group compared with the control group (MD = −23.1, 95% CI: −37.27 to −8.94, P = 0.001; MD = −105.69, 95% CI: −174.20 to −37.19, P = 0.002). No serious adverse events of TEAS were reported in any of the referenced studies. Conclusion TEAS has an obvious curative effect in preventing POD and pain in the earlier stage of surgical patients. It could be a promising assisted anesthesia technique in the future.

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Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

Cited by 8 publications

References 136 publications

Relationship of Postoperative Serum Neuro-Specific Enolase Levels with Postoperative Delirium Occurring after Microvascular Depression Surgery in Older Patients

Relationship of Postoperative Serum Neuro-Specific Enolase Levels with Postoperative Delirium Occurring after Microvascular Depression Surgery in Older Patients

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Transcutaneous Electrical Acupoint Stimulation for Preventing Postoperative Delirium: A Meta-Analysis

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