The effect of intravenous and inhalational maintenance of anaesthesia on postoperative cognitive outcomes in elderly people

Amare, Mulubrhan; McEvoy, Mark; Smith, A. F.

doi:10.1111/anae.14758

Cited by 5 publications

(8 citation statements)

References 5 publications

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“…In this single-centre, retrospective registry study, the use of Regional anaesthesia 9088 (10.7%) 2304 (9.7%) SPORC, score for prediction of postoperative respiratory complications; PEEP, positive end-expiratory pressure; PIP, peak inspiratory pressure; NMBD, neuromuscular blocking drugs; ED95, median effective dose required to achieve a 95% reduction in maximal twitch response from baseline; MAP, mean arterial pressure. complications have generally been centred on a comparison between volatile agents and total intravenous anaesthesia [9,10], noting that the use of volatile agents is associated with a reduction in risk of postoperative pulmonary complications and mortality [11]. From these studies, it remains unclear if one volatile agent conferred a greater safety benefit over another.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies that have evaluated the association between volatile anaesthetics and postoperative respiratory complications have generally been centred on a comparison between volatile agents and total intravenous anaesthesia [9, 10], noting that the use of volatile agents is associated with a reduction in risk of postoperative pulmonary complications and mortality [11]. From these studies, it remains unclear if one volatile agent conferred a greater safety benefit over another.…”

Section: Discussionmentioning

confidence: 99%

“…Through this study, we intended to address this critical knowledge gap by evaluating the association of early postoperative respiratory complications with the use of desflurane. Studies centred on the comparison of volatile agents and total intravenous anaesthesia [9,10] noted that the use of volatile agents is associated with a reduction in frequency of postoperative pulmonary complications [11], with some evidence that there was no difference in outcome between volatile agents [12]. We, therefore, decided to explore this relationship in depth through a focused comparative analysis.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

et al. 2020

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Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (S p O 2 < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and subgroup analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m À2); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all subgroups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

et al. 2020

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“…Inhalation anesthesia is considered to be one of the important contributors to POCD. [3][4][5] Zhi Wang et al showed that isoflurane may cause hippocampal inflammation and cognitive impairment by inducing NLRP3 inflammasome activation in the brains of aged mice. 26 However, the results of research on sevoflurane, a more commonly used anesthetic in the clinic, are controversial.…”

Section: Discussionmentioning

confidence: 99%

Histone deacetylase 9 plays a role in sevoflurane‐induced neuronal differentiation inhibition by inactivating cAMP‐response element binding protein transcription and inhibiting the expression of neurotrophin‐3

Li,

Wang,

et al. 2023

The FASEB Journal

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Postoperative cognitive decline (POCD) is a common and serious complication following anesthesia and surgery; however, the precise mechanisms of POCD remain unclear. Our previous research showed that sevoflurane impairs adult hippocampal neurogenesis (AHN) and thus cognitive function in the aged brain by affecting neurotrophin‐3 (NT‐3) expression; however, the signaling mechanism involved remains unexplored. In this study, we found a dramatic decrease in the proportion of differentiated neurons with increasing concentrations of sevoflurane, and the inhibition of neural stem cell differentiation was partially reversed after the administration of exogenous NT‐3. Understanding the molecular underpinnings by which sevoflurane affects NT‐3 is key to counteracting cognitive dysfunction. Here, we report that sevoflurane administration for 2 days resulted in upregulation of histone deacetylase 9 (HDAC9) expression, which led to transcriptional inactivation of cAMP‐response element binding protein (CREB). Due to the colocalization of HDAC9 and CREB within cells, this may be related to the interaction between HDAC9 and CREB. Anyway, this ultimately led to reduced NT‐3 expression and inhibition of neural stem cell differentiation. Furthermore, knockdown of HDAC9 rescued the transcriptional activation of CREB after sevoflurane exposure, while reversing the downregulation of NT‐3 expression and inhibition of neural stem cell differentiation. In summary, this study identifies a unique mechanism by which sevoflurane can inhibit CREB transcription through HDAC9, and this process reduces NT‐3 levels and ultimately inhibits neuronal differentiation. This finding may reveal a new strategy to prevent sevoflurane‐induced neuronal dysfunction.

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“…One potential risk factor for POCD is the use of anesthetic agents (4). Widely used narcotics are currently classified into inhalational and intravenous anesthetics (5). Inhalational general anesthetics such as isoflurane and halothane have been demonstrated to increase the risk of Alzheimer's disease (AD) in the aging brain (6), and exert a neurotoxic effect via caspase-mediated apoptosis (7).…”

Section: Introductionmentioning

confidence: 99%

Characterization of DNA hydroxymethylation in the hypothalamus of elderly mice with post‑operative cognitive dysfunction

Zhong

Wang

2019

Exp Ther Med

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Post-operative cognitive dysfunction (POCD) is a common syndrome characterized by perioperative cerebral damage in elderly patients, including cognitive impairment and memory loss. Recent studies have revealed that anesthesia is one of the key causes of POCD. Ubiquitin-like with PHD and ring finger domains 2 (Uhrf2) has been reported to play a crucial role in regulating DNA methylation and hydroxymethylation, which are closely connected with memory building and erasure. However, whether narcotic drugs can affect Uhrf2 to impact on DNA methylation and hydroxymethylation in POCD is poorly understood. In this study, a POCD model was established in elderly mice through sevoflurane treatment, and these mice were found to have compromised levels of global DNA 5′-hydroxymethylcytosine (5hmC) and Uhrf2 in the hippocampus and the amygdaloid nucleus, when compared with non-POCD and control mice. The results of immunoprecipitation and quantitative PCR revealed that 5hmC modification of the promoters of genes associated with neural protection and development, such as glial cell-derived neurotrophic factor, brain derived neurotrophic factor, glucocorticoid receptor and acyl-CoA sythetase short chain family member 2, was reduced in the hippocampus of POCD mice when compared with non-POCD and control mice. Taken together, the findings of the present study suggest that loss of 5hmC, in the hippocampus and the amygdaloid nucleus modulated by Uhrf2 suppression, may result in the learning and memory ability impairment seen in mice with POCD.

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The effect of intravenous and inhalational maintenance of anaesthesia on postoperative cognitive outcomes in elderly people

Cited by 5 publications

References 5 publications

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

Histone deacetylase 9 plays a role in sevoflurane‐induced neuronal differentiation inhibition by inactivating cAMP‐response element binding protein transcription and inhibiting the expression of neurotrophin‐3

Characterization of DNA hydroxymethylation in the hypothalamus of elderly mice with post‑operative cognitive dysfunction

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