Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation

Abstract

Background: Studies have shown that perioperative inflammatory response is one of the important factors that caused postoperative cognitive dysfunction (POCD). Ulinastatin is a broad-spectrum protease inhibitor that inhibits inflammatory. We investigated the effects of ulinastatin on inflammatory response and early postoperative cognitive function in elderly patients undergoing spinal surgery.Methods: This clinical trial was approved by the Xuanwu Hospital Ethical Committee (Registration number: ChiCTR-IPR-16008931). Sixty elderly patients undergoing elective spinal surgery with American Society of Anesthesiologists (ASA) status of I–II were randomized into ulinastatin and control groups; total intravenous anesthesia was performed. The elderly patients in ulinastatin group underwent intravenous infusion of ulinastatin 10,000 units/kg following anesthesia induction and before surgical incision, and 5000 units/kg on post-operative days 1 and 2. Cognitive function was determined with Montreal Cognitive Assessment (MOCA) test preoperatively and on post-operative day 7 by a neurologist. Serum lipopolysaccharide (LPS), interleukin-6 (IL-6), C-reactive protein (CRP), and matrix metalloprotease-9 (MMP-9) concentration levels were measured at baseline, the end of surgery, and on post-operative days 1 and 3.Results: All elderly patients completed the study. Ulinastatin infusion significantly reduced the incidence of POCD in elderly patients undergoing spine surgery (ulinastatin group 16% vs. control group 43%, χ2 = 5.079, P = 0.024, P < 0.05). The elderly patients in ulinastatin group exhibited lower serum LPS, IL-6, CRP, and MMP-9 concentrations, as well as a shortened peak value duration, compared with those in the control group following surgery (P < 0.05).Conclusion: Systemic inflammation and translocation of LPS were inhibited by the infusion of ulinastatin in elderly patients undergoing spinal surgery. The anti-inflammation intervention with ulinastatin can significantly improve the elderly patients’ postoperative cognitive function.

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

“…As reported, POCD occurs in 65% of patients discharged after CABG surgery and in ∼40% in the months following surgery on average [22]. The 21-day POCD incidence of 27.1% in the present study is similar with previous reports [23][24][25]. RDW suggests the heterogeneity of red blood cell size, and reflects the relative number and function of red blood cells.…”

Elamipretide (SS-31) Improves Functional Connectivity in Hippocampus and Other Related Regions Following Prolonged Neuroinflammation Induced by Lipopolysaccharide in Aged Rats

“…Few studies have investigated whether inhibiting the hippocampus neuroinflammation or interrupting related signaling pathway improves the brain function in other regions. In one of our clinical studies, we reported improvements in cognitive test performance after anti-inflammatory treatment in elderly patients following spinal surgery (Zhang et al, 2018 ). However, rs-fMRI was not applied in this study so the function in other brain regions could not be fully assessed.…”

Exosome α-Synuclein Release in Plasma May be Associated With Postoperative Delirium in Hip Fracture Patients

“…The eventual choice of anesthetic regimen (general anesthesia or neuraxial block) was based on the preference and experience of the anesthesiologist alongside discussion with the patient and their family. A uniform anesthetic regimen was conducted based on previous studies of orthopedic operations in older adults (Zhang et al, 2018). In order to minimize postoperative pain, a second fascia iliac block with the aforementioned protocol was provided right before anesthesia regardless of the anesthetic regimen.…”