Cognitive decline after carotid endarterectomy

Aceto, Paola; Lai, Carlo; Crescenzo, Franco De; Crea, Maria Antonietta; Franco, Valeria Di; Pellicano, Gaia Romana; Perilli, Valter; Lai, Silvia; Papanice, Domenico; Sollazzi, Liliana

doi:10.1097/eja.0000000000001130

Cited by 21 publications

(15 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cognitive changes after anesthesia also include postoperative neurocognitive disorders. Specific risk factors for such disorders should be evaluated in susceptible patients [148,149].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

“…Older patients are more sensitive to adverse effects of opioids and NSAIDs, and more prone to postoperative morbidity. The combination of opioid-free general anesthesia with neuraxial or regional local anesthesia, according to ERAS principles, is indicated in this situation [ 148 ]. Morphine is an effective analgesic for moderate or severe pain, but should be administered cautiously, particularly in patients with poor renal or respiratory function, cognitive impairment, or both [ 36 ].…”

Section: Postoperative Carementioning

confidence: 99%

See 1 more Smart Citation

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

show abstract

“…Cognitive changes after anesthesia also include postoperative neurocognitive disorders. Specific risk factors for such disorders should be evaluated in susceptible patients [148,149].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Section: Postoperative Carementioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…The systematic search identified 330 de-duplicated articles ( Figure 1 ). After applying the inclusion criteria, 11 reviews of 73 risk factors were included for review [ 28 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. A number of the reviews examined the same risk factor but for a different type of surgery.…”

Section: Resultsmentioning

confidence: 99%

Peri-Operative Risk Factors Associated with Post-Operative Cognitive Dysfunction (POCD): An Umbrella Review of Meta-Analyses of Observational Studies

Travica

Lotfaliany

Marriott

et al. 2023

JCM

View full text Add to dashboard Cite

This umbrella review aimed to systematically identify the peri-operative risk factors associated with post-operative cognitive dysfunction (POCD) using meta-analyses of observational studies. To date, no review has synthesised nor assessed the strength of the available evidence examining risk factors for POCD. Database searches from journal inception to December 2022 consisted of systematic reviews with meta-analyses that included observational studies examining pre-, intra- and post-operative risk factors for POCD. A total of 330 papers were initially screened. Eleven meta-analyses were included in this umbrella review, which consisted of 73 risk factors in a total population of 67,622 participants. Most pertained to pre-operative risk factors (74%) that were predominantly examined using prospective designs and in cardiac-related surgeries (71%). Overall, 31 of the 73 factors (42%) were associated with a higher risk of POCD. However, there was no convincing (class I) or highly suggestive (class II) evidence for associations between risk factors and POCD, and suggestive evidence (class III) was limited to two risk factors (pre-operative age and pre-operative diabetes). Given that the overall strength of the evidence is limited, further large-scale studies that examine risk factors across various surgery types are recommended.

show abstract

“…Reperfusion brain injury (luxury perfusion) after carotid endarterectomy is recently being recognized as an unwanted, hazardous neurological deficit [1, 2]. The most important risk factors in reperfusion brain injury are diminished cerebrovascular reserve, postmaneuver hypertension, and hyperperfusion lasting more than several hours after carotid endarterectomy [3].…”

Section: Discussionmentioning

confidence: 99%

“…Luxury perfusion has been regarded a rather plausible phenomenon after spontaneous or endovascular intervention-induced recanalization of ischemic stroke. It has recently been recognized that neurological deterioration might also occur by reperfusion brain injury after carotid endarterectomy [1, 2]. In contrast, in acute ischemic stroke, this phenomenon has been rarely described thus far.…”

Section: Introductionmentioning

confidence: 99%