Deeper Total Intravenous Anesthesia Reduced the Incidence of Early Postoperative Cognitive Dysfunction After Microvascular Decompression for Facial Spasm

Abstract

Deeper total intravenous anesthesia can decrease the incidence of cognitive dysfunction in the early postoperative period.

BIS‐guided deep anesthesia decreases short‐term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery

“…As a BIS value of 45 is generally regarded as the dividing line between “light” anesthesia and “deep” anesthesia, BIS values ranging from 30 to 45 are treated here as “deep” anesthesia and 45–60 as “light” anesthesia. This allowed for the target BIS values to be maintained for more than 80% of the total time from the induction to the cessation of anesthesia, as reported previously (An et al., ).…”

“…The choice of BIS targets for Deep and Light groups is based on previous studies. Two studies (An et al., ; Farag et al., ) defined lighter anesthesia as being a BIS target of 50–60 and deeper anesthesia as BIS target of 30–40. The underlying large‐scale randomize study (Short et al., ) which would recruite 6,500 patients with 40 to 50 centers internationally defined “light” anesthesia as a BIS target of 50 and “deep” anesthesia as a BIS target of 35.…”

“…Previous data indicate that deeper levels of combined intravenous inhalation anesthesia, as measured by the Bispectral Index (BIS), was associated with better cognitive function at 4–6 weeks after noncardiac surgery in patients older than 50 years (Farag, Chelune, Schubert, & Mascha, ). Another study reported that deeper total intravenous anesthesia, as guided by BIS, could decrease the incidence of POCD at 5 days after microvascular decompression in patients aged 28–67 years (An et al., ). One more study also found that deeper depth of anesthesia guided by AAI (AEP index) decreased the incidence of POCD, defined as MMT (the mini‐mental test) scores below 25, at 1 day after ophthalmic surgery under general anesthesia (Jildenstal, Hallen, Rawal, Gupta, & Berggren, ).…”

“…However, there have been some mixed results, with one study showing no significant association of general anesthesia depth and POCD at 7 days following elective noncardiac surgery in elderly patients (Steinmetz & Funder, ), whilst another study found no association of general anesthesia depth and POCD at 7 days and 3 months after surgery in elderly patients (Radtke et al., ). However, a number of factors complicate the interpretation of previous data, including anesthetic depth beyond the planned target range and combinations too many of commonly prescribed drugs (Farag et al., ), lack of age stratification (An et al., ), small sample sizes (Steinmetz & Funder, ), and a lack of group randomization (Radtke et al., ). Clearly more carefully collected data are required to better clarify the association of anesthesia depth and POCD, especially for elderly patients.…”

Lighter compared to deeper isoflurane anaesthesia can affect recognition memory in male C57BL/6 mice

“…Concerns have been raised regarding how deeply individuals are anaesthetized and how this depth can affect post-anaesthetic behaviour (Culley et al 2004;Valentim et al 2008a;Valentim et al 2008b;Valentim et al 2010;Zurek et al 2012). Some studies have shown that Post-operative cognitive dysfunction was identified after light, but not deep, anaesthesia in humans (An et al 2011;Farag et al 2006). In mice, several studies showed that the anaesthetic that is most used in laboratory rodents, isoflurane, induces transient deficits of spatial memory (Culley et al 2004;Zurek et al 2012), especially when light anaesthetic depth is used (Valentim et al 2008a;Valentim et al 2010).…”