Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction: a preliminary study

Abstract

PurposeThis study aims to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients with silent lacunar infarct and preliminarily to determine the relationship among TEAS, blood–brain barrier (BBB), neuroinflammation, and POD.Patients and methodsSixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C). Patients in the group TEAS received TEAS (disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of both sides starting from 30 minutes before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. At 0 minute before the treatment of TEAS, 30 minutes after skin incision, and after completion of surgery (T1–3), blood samples were extracted to detect the concentration of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), and S100β. We assessed patients for delirium and coma twice daily in the first 3 postoperative days using the Confusion Assessment Method for the intensive care unit and the Richmond Agitation-Sedation Scale.ResultsThis study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were significantly increased at T2–3 in both the groups (P<0.05). Compared with group TEAS, serum levels of TNF-α and IL-6 were higher at T2–3 and serum levels of MMP-9 and S100β were higher at T3 in group C (P<0.05). The intraoperative anesthetic consumptions were less in group TEAS than group C.ConclusionTEAS can alleviate POD in older patients with silent lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of BBB.

Serum biomarkers of delirium in the elderly: a narrative review

“…Like albumin, ASAT was not the focus of the study cited here [24]. Among inflammatory markers, increased procalcitonin [27], CRP [24, 27, 28, 30–32, 41, 45, 46], and IL-6 [25, 27, 28, 34, 35, 44, 46] were consistently reported to be associated with delirium with the exception of one study that found no increase in IL-6 levels [33]. Of note, in this study, IL-6 was collected early (i.e., venous blood was drawn at 06:00 on the first day after surgery).…”

“…Leptin levels were significantly lower in patients with delirium compared to those without [36]. Finally, AZGP1 [29], MMP-9 [44], neopterin [42], phenylalanine–tyrosine ratio [42], SERPINA3 [29], thioredoxin [37], and 8-iso-prostaglandin F2α [38] were linked to postoperative delirium.…”

Effects of Transcutaneous Electrical Acupoint Stimulation on Postoperative Cognitive Decline in Elderly Patients: A Pilot Study

“… 13 Previous studies from our group showed that TEAS can improve cognitive decline in elderly patients with focal lacunar infarction. 14 However, the effects of TEAS on POCD in elderly patients undergoing laparoscopic radical resection of colon cancer remain to be explored.…”

Effects of acupuncture on postoperative recovery and extubation time

“…[ 5 ] Acupuncture could also improve postoperative pain and reduce opioid use [ 9 ] and might be beneficial in the prevention and treatment of postoperative nausea and vomiting. [ 10 ] Furthermore, acupuncture might alleviate excessive inflammation after surgery by reducing levels of interleukin (IL)-1 β, [ 11 ] IL-6, [ 12 ] and S100β. [ 5 ] Therefore, acupuncture might be helpful to relieve postoperative symptoms such as delirium, pain, nausea, and vomiting and enhance postoperative recovery.…”