Ambulatory anaesthesia and cognitive dysfunction

Rasmussen, Lars S.; Steinmetz, Jacob

doi:10.1097/aco.0000000000000247

Cited by 26 publications

(13 citation statements)

References 21 publications

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“…Fitness for a procedure should relate to the patient's functional status as determined at pre‐anaesthetic assessment, and not by ASA physical status, age or body mass index . Patients with a stable chronic disease such as diabetes are often better managed as day cases because there is minimal disruption to their daily routine .…”

Section: Selection Of Patientsmentioning

confidence: 99%

Guidelines for day‐case surgery 2019

et al. 2019

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Section: Selection Of Patientsmentioning

confidence: 99%

Guidelines for day‐case surgery 2019

et al. 2019

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“…Post-operative cognitive dysfunction (POCD) is widely observed in the elderly in post-operative periods, resulting in the increase of medical care, patient burden and mortality (Smith et al, 2018 ). POCD causes alterations of learning, memory and behavior that can last for weeks or months after anesthesia and surgery, leading to short-term or long-term cognitive disruption (Rasmussen and Steinmetz, 2015 ). It is therefore urgent to develop pharmacological treatments for this disorder.…”

Section: Introductionmentioning

confidence: 99%

Tacrine(10)-Hupyridone Prevents Post-operative Cognitive Dysfunction via the Activation of BDNF Pathway and the Inhibition of AChE in Aged Mice

Chen

et al. 2018

Front. Cell. Neurosci.

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Post-operative cognitive dysfunction (POCD) could cause short-term or long-term cognitive disruption lasting weeks or months after anesthesia and surgery in elderly. However, no effective treatment of POCD is currently available. Previous studies indicated that the enhancement of brain-derived neurotrophic factor (BDNF) expression, and the elevation the cholinergic system, might be effective to prevent POCD. In this study, we have discovered that tacrine(10)-hupyridone (A10E), a novel acetylcholinesterase (AChE) inhibitor derived from tacrine and huperzine A, could prevent surgery-induced short-term and long-term impairments of recognition and spatial cognition, as evidenced by the novel object recognition test and Morris water maze (MWM) tests, in aged mice. Moreover, A10E significantly increased the expression of BDNF and activated the downstream Akt and extracellular regulated kinase (ERK) signaling in the surgery-treated mice. Furthermore, A10E substantially enhanced choline acetyltransferase (ChAT)-positive area and decreased AChE activity, in the hippocampus regions of surgery-treated mice, indicating that A10E could prevent surgery-induced dysfunction of cholinergic system, possibly via increasing the synthesis of acetylcholine and the inhibition of AChE. In conclusion, our results suggested that A10E might prevent POCD via the activation of BDNF pathway and the inhibition of AChE, concurrently, in aged mice. These findings also provided a support that A10E might be developed as a potential drug lead for POCD.

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“…Recovery improved over time in both normal and low‐baseline groups in a manner that is consistent with previous data , indicating that the new scoring system produces similar results in low‐baseline participants to the normal baseline participants. This similarity of cognitive recovery between groups that have normal vs. low‐baseline cognition has potentially important clinical implications given the current debate regarding the relationship between pre‐existing cognitive impairment and poor postoperative cognitive function , and emphasises the need to validate a scoring system with which to measure cognitive recovery in those patients with a low pre‐operative baseline.…”

Section: Discussionmentioning

confidence: 94%

“…Postoperative cognitive dysfunction (POCD) is associated with serious morbidity and mortality . Cognitive decline is common after major surgery , particularly in the elderly , making cognitive recovery an important determinant of overall long‐term surgical outcome. Early detection of cognitive recovery may alert healthcare practitioners to the risk of poor overall recovery and, possibly, provide opportunity for early intervention.…”

Section: Introductionmentioning

confidence: 99%

Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low‐baseline cognition

et al. 2018

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Patients with pre-surgery cognitive impairment cannot currently be assessed for cognitive recovery after surgery using the Postoperative Quality of Recovery Scale (PostopQRS), as they would mathematically be scored as recovered. We aimed to validate a novel method to score cognitive recovery in patients with low-baseline cognition, using the number of low-score tests rather than their numerical values. Face validity was demonstrated in 86 participants in whom both the Postoperative Quality of Recovery Scale and an 11-item neuropsychological battery were performed. The Postoperative Quality of Recovery Scale agreed with neuropsychological categorisation of low vs. normal cognition 74% of the time, with all but five incorrectly coded participants deviating by only one neurocognitive test. Cognitive recovery over time was comparable for groups with differing baseline cognitive function, irrespective of whether the Postoperative Quality of Recovery Scale or neuropsychological methods were used. Discriminant validation was demonstrated in a post-hoc analysis of the steroids in cardiac surgery substudy by allocating groups to normal (n = 246) or low-baseline cognition (n = 231) stratified by cognitive recovery on day 1. Recovery was similar for participants with low and normal baseline cognition. Postoperative length of stay was longer in patients with failed cognitive recovery whether they had normal mean (SD) (10.4 (10.0) vs. 8.0 (5.9) days, p = 0.02) or low-baseline cognition (12.0 (11.1) vs. 8.2 (4.7) days, p < 0.01). Overall quality, as well as cognitive, emotive and physiological recovery was independent of baseline cognition. The modified scoring method for the Postoperative Quality of Recovery Scale cognitive domain demonstrates acceptable face and discriminant validity.

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Ambulatory anaesthesia and cognitive dysfunction

Cited by 26 publications

References 21 publications

Guidelines for day‐case surgery 2019

Guidelines for day‐case surgery 2019

Tacrine(10)-Hupyridone Prevents Post-operative Cognitive Dysfunction via the Activation of BDNF Pathway and the Inhibition of AChE in Aged Mice

Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low‐baseline cognition

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