Postoperative Störungen der kognitiven Leistungsfähigkeit bei älteren Patienten Die Ergebnisse der „International Study of Postoperative Cognitive Dysfunction” (ISPOCD 1)

Biedler, A.; Juckenhöfel, Stephanie; Larsen, Reinhard; Radtke, Frank‐Olaf; Stotz, Andreas; Warmann, J.; Braune, E.; Dyttkowitz, A.; Henning, F.; Strickmann, Bernd; Lauven, P. M.

doi:10.1007/s001010050802

Cited by 48 publications

(16 citation statements)

References 11 publications

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“…Additionally, short-term cognitive impairment, common after general anesthesia, is typically attributed to incomplete clearance of the anesthetic (Moller et al, 1993). The delayed onset of cognitive dysfunction in our study mimics the clinical incidence of POCD in elderly surgical patients (Moller et al, 1998; Biedler et al, 1999). The delayed presence of spatial learning impairments demonstrated here may result in disruption in learning and memory signaling pathways that occurs over time.…”

Section: Discussionsupporting

confidence: 63%

“…In clinical studies, the detection of POCD occurs within weeks following anesthetic exposure and manifests as long-term cognitive deficits on cognitive tasks (Moller et al, 1998; Biedler et al, 1999; Monk et al, 2008;). There may be an interaction of advancing age and anesthetic insult that result in cognitive dysfunction for some elderly patients.…”

Section: Discussionmentioning

confidence: 99%

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Isoflurane/nitrous oxide anesthesia induces increases in NMDA receptor subunit NR2B protein expression in the aged rat brain

et al. 2012

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Postoperative cognitive dysfunction, POCD, afflicts a large number of elderly surgical patients following surgery with general anesthesia. Mechanisms of POCD remain unclear. N-methyl-D-aspartate (NMDA) receptors, critical in learning and memory, that display protein expression changes with age are modulated by inhalation anesthetics. The aim of this study was to identify protein expression changes in NMDA receptor subunits and downstream signaling pathways in aged rats that demonstrated anesthesia-induced spatial learning impairments. Three-month-old and 18-month-old male Fischer 344 rats were randomly assigned to receive 1.8% isoflurane/70 % nitrous oxide (N2O) anesthesia for 4h or no anesthesia. Spatial learning was assessed at 2 weeks and 3 months post-anesthesia in Morris water maze. Hippocampal and cortical protein lysates of 18-month-old rats were immunoblotted for activated caspase 3, NMDA receptor subunits, and extracellular-signal regulated kinase (ERK) 1/2. In a separate experiment, Ro 25-6981 (0.5mg/kg dose) was administered by I.P. injection before anesthesia to 18-month-old rats. Immunoblotting of NR2B was performed on hippocampal protein lysates. At 3 months post-anesthesia, rats treated with anesthesia at 18-months-old demonstrated spatial learning impairment corresponding to acute and long-term increases in NR2B protein expression and a reduction in phospho-ERK1/2 in the hippocampus and cortex. Ro 25-6981 pretreatment attenuated the increase in acute NR2B protein expression. Our findings suggest a role for disruption of NMDA receptor mediated signaling pathways in the hippocampus and cortex of rats treated with isoflurane/ N2O anesthesia at 18-months-old, leading to spatial learning deficits in these animals. A potential therapeutic intervention for anesthesia associated cognitive deficits is discussed.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Isoflurane/nitrous oxide anesthesia induces increases in NMDA receptor subunit NR2B protein expression in the aged rat brain

et al. 2012

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“…Darüber hinaus zeigten sich keine Korrelationen zwischen zerebraler Dysfunktion und Episoden von arterieller Desaturation und Hypotension [2,12,28]. In mehreren prospektiven Studien wurden ältere Patienten, die sich einem orthopädischen Eingriff an den unteren Extremitäten unterzogen, bis zu 6 Monate nach der Operation neuropsychologisch untersucht.…”

Section: Anästhesie Und Perioperativer Schlaganfallunclassified

Anästhesie und perioperativer Schlaganfall

Merk

Forst²

2000

Der Anaesthesist

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“…In addition to the susceptibility of POCD following cardiac surgeries, some patients that undergo non-cardiac procedures involving general anesthesia also present with POCD. The elderly are the most vulnerable patient population [4]. Another risk factor includes the patient's level of education, suggesting that a "cognitive reserve" in individuals with higher levels of education offer a protection against POCD.…”

mentioning

confidence: 99%

“…One must consider that the surgical event, juxtaposed to the anesthetic agents themselves, may exert its effects through different pathophysiological mechanisms. Interestingly, patient co-morbidities and the duration of anesthesia are independent risk factors for POCD [4], suggesting the importance of all aspects of surgery. Potential perioperative events, such as cerebral hypoxia (i.e.…”

mentioning

confidence: 99%

Modeling Post-Operative Cognitive Dysfunction in Zebrafish

McElroy¹,

Mustard²,

Kamran³

et al. 2016

AAD

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Permanent post-operative cognitive dysfunction (POCD) is a grim outcome to an estimated 6% of elderly surgical patients. Volatile anesthetics impact neuronal tissue independent of effects attributed to the physical trauma of the surgery itself. While it is recognized that all aspects related to surgery may contribute to cognitive loss in some manner, the present paper focuses on the role of volatile anesthetics in promoting POCD. There is an increased risk of onset and progression of Alzheimer's disease (AD) from POCD, implying that the neuropathogenesis between the two is similar. Human studies, being ethically limited in scope, require animal models as a substitute. While the literature using rodent models contains valuable information, we believe that the accessible and practical zebrafish will greatly enhance our further understanding of the molecular mechanism of POCD as it relates to AD. Disease genes and fundamental neurobehaviors of these teleost fish mirror those of mammals and humans, validating their use as a core research model for AD. Since the gradual senescence seen in zebrafish also resembles that found in humans, we numerically correlated the two lifespans, offering researchers a computational tool. Zebrafish, being aquatic animals, necessitates the use of miscible compounds, such as trifluoroethanol, whose anesthetic potency we are presenting. We also review the rodent and zebrafish literature relevant to POCD. Continued research with the leading-edge zebrafish unlocks the possibility that, in the future, perioperative intervention will prevent POCD.

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Postoperative Störungen der kognitiven Leistungsfähigkeit bei älteren Patienten Die Ergebnisse der „International Study of Postoperative Cognitive Dysfunction” (ISPOCD 1)

Cited by 48 publications

References 11 publications

Isoflurane/nitrous oxide anesthesia induces increases in NMDA receptor subunit NR2B protein expression in the aged rat brain

Isoflurane/nitrous oxide anesthesia induces increases in NMDA receptor subunit NR2B protein expression in the aged rat brain

Anästhesie und perioperativer Schlaganfall

Modeling Post-Operative Cognitive Dysfunction in Zebrafish

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