Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients

Rasmussen, Lars S.; Johnson, Tim; Kuipers, HM Harrie; Kristensen, Diana; Siersma, VD Volkert; Vila, P.; Jolles, J.; Παπαϊωάννου, Αλεξάνδρα; Abildstrøm, Hanne; Silverstein, J. H.; Bonal, JA; Ræder, Johan; Ik, Nielsen; Korttila, K.; Muñoz, L Fernández; Dodds, Chris; Hanning, C.D.; Møller, Jes Fabricius

doi:10.1034/j.1399-6576.2003.00057.x

Cited by 521 publications

(338 citation statements)

References 26 publications

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“…The 17.8% POCD incidence rate found in our study is in the range reported in previous studies as well as the observation that preexisting impaired cognitive function is one of the strongest risk factors for POCD [5][6][7]. Furthermore our study confirms previous reports that POCD may also occur in adult patients at younger ages [1][2][3][4][5].…”

Section: Commentsupporting

confidence: 91%

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Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study

Schoenenberger

Burkhard

Thalmann

et al. 2016

Urology

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Objectives: To evaluate cognitive trajectories after radical cystectomy and their impact on surgical outcomes, including urinary continence. Results: Mean age was 67.9 ± 9.3 years (range 40 -88 years). Sixty-six patients (73.3%) had stable cognition, nine patients (10.0%) persistent and seven patients (7.8%) transient deterioration, five patients (5.6%) persistent and three patients (3.3%) transient improvement. An impaired preoperative cognition was the only significant risk factor of short-term cognitive deterioration (OR adjusted for age and sex 9.4, 95%CI 1.6-56.5, p=0.014). Cognition showed no associations with 1-year mortality, 90-day complication rate, cancer progression or duration of in-hospital stay. Patients with transient or persistent cognitive deterioration had an increased risk for nighttime incontinence (OR adjusted for age and sex 5.1, 95%CI 1.1-22.4, p=0.032). Methods Conclusions:In this study, the majority of patients showed stable cognition after major abdominopelvic surgery. Cognitive deterioration occurred in a small subgroup of patients, and an impaired preoperative cognition was the only significant risk factor.Postoperative cognitive deterioration was associated with nighttime incontinence.3

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Section: Commentsupporting

confidence: 91%

“…The incidence of postoperative cognitive dysfunction (POCD) varies greatly with reported rates of 4% to 41% after major surgery [5][6][7]. Most POCD cases recover within a few weeks following surgery and anesthesia [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study

Schoenenberger

Burkhard

Thalmann

et al. 2016

Urology

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“…However, the second study published in 2003 (ISPOD2) found no significant difference in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia 91. Accordingly, there is no evidence to suggest any causative relationship between general anaesthesia and long‐term POCD.…”

Section: Surgery and Cognitive Dysfunctionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

346

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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“…14 However, a randomized study of 438 elderly patients compared general vs regional anesthesia and found that the latter decreased the incidence of POCD seven days after major noncardiac surgery. 15 There was no significant difference between S-100ß and NSE levels in patients receiving either anesthetic technique, suggesting that no structural neurologic insult occurred. In a recent study, S-100ß has been shown to increase after major abdominal surgery, while NSE was decreased.…”

Section: Conclusion : Le Premier Jour Après Une Opération Mineure L'mentioning

confidence: 99%

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly

Rohan

Buggy

Crowley

et al. 2005

Can J Anesth/J Can Anesth

110

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P Pu ur rp po os se e: : Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ß protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery.M Me et th ho od ds s: : Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100ß protein and NeuronSpecific Enolase levels were also documented.R Re es su ul lt ts s: : POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100ß protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values. C Co on nc cl lu us si io on n: : The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100ß protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique. Objectif : Le dysfonctionnement cognitif postopératoire (DCPO) se manifeste chez 26 % des patients âgés, sept jours après une opéra-tion non cardiaque majeure. Nous avons évalué l'incidence de DCPO et les modifications des marqueurs sériques d'atteinte neuronale (protéine S-100ß et énolase neurospécifique), 24 h après une anesthésie à un seul médicament, le propofol ou le sévoflurane, chez des patients âgés qui ont subi une opération mineure. Méthode : Les patients (n = 30, moyenne de 73 ans, limites de 65-86 ans) opérés pour cystoscopie ou hystéroscopie, ont été randomisés à l'insu d'un observateur pour une anesthésie avec propofol ou sévoflurane. Les changements aux tests neuropsychologiques (test Stroop, test modifié de remémoration de mots) ont été notés 24 h après l'opération et comparés à ceux de sujets témoins appariés selon

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Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients

Cited by 521 publications

References 26 publications

Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study

Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly

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