The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty: A randomized controlled trial

Fan, Yunxia; Yuan, Liang; Ji, Mu‐Huo; Yang, Jianjun; Gao, Derong

doi:10.1016/j.jclinane.2017.03.023

Cited by 51 publications

(75 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Heightened levels of postoperative proinflammatory cytokines can also prevent the synthesis of pineal melatonin (Pontes, Cardoso, Carneiro‐Sampaio, & Markus, ), suggesting that the raised cytokine levels evident in the Light group, may be associated with alterations in circadian regulation, as well as the antioxidant, anti‐inflammatory, and mitochondria‐optimizing effects of melatonin (Polyakova et al., ). The presurgical administration of melatonin can decrease POCD incidence in elderly patients (Fan, Yuan, Ji, Yang, & Gao, ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

Objectives Postoperative cognitive dysfunction (POCD) is a common clinical complication, with an underlying pathophysiology linked to heightened levels of neuroinflammation. However, it requires clarification as to whether the depth of anesthesia modulates postoperative cognitive dysfunction. This study investigated the association between depth of anesthesia and POCD in elderly patients undergoing abdominal surgery. Methods A total of 120 patients aged 60 years or older who were planned for abdominal surgery under total intravenous anesthesia were included in this study. The depth of anesthesia was guided by monitoring Bispectral Index (BIS) data. All study participants completed a battery of nine neuropsychological tests before surgery and at 7 days and 3 months after surgery. POCD was calculated by using the reliable change index. Plasma concentration of C‐reactive protein (CRP), interleukin (IL)‐1β, IL‐10, S‐100β, and norepinephrine (NE) were measured. Results The incidence of POCD at 7 days after surgery in the deep anesthesia group was 19.2% (10/52), which was significantly lower (p = 0.032) than the light anesthesia group 39.6% (21/53). The depth of anesthesia had no effect on POCD at 3 months after surgery (10.3% vs 14.6%, respectively, p = 0.558). Similarly, plasma levels of CRP and IL‐1β in deep anesthesia group were lower than that in light anesthesia group at 7 days after surgery (p < 0.05), but not at 3 months after surgery (p > 0.05). There were no significant differences in the plasma concentration of IL‐10, S‐100β, and NE between the groups (p > 0.05). Conclusions Deep anesthesia under total intravenous anesthesia could decrease the occurrence of short‐term POCD and inhibit postoperative peripheral inflammation in elderly patients undergoing abdominal surgery, compared with light anesthesia.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…There were a total of nine articles (five RCTs, two retrospective medical record reviews, one non-randomized observational study, and one case report) describing the role of either melatonin or ramelteon in preventing delirium ( 37 – 45 ) summarized in Table 1 . Six of these examined the effect of melatonin ( 37 – 40 , 42 , 44 ) and three, ramelteon ( 41 , 43 , 45 ).…”

Section: Resultsmentioning

confidence: 99%

“…Four RCTs have examined the efficacy of melatonin in preventing delirium with contradictory results ( 38 , 39 , 40 , 44 ).…”

Section: Resultsmentioning

confidence: 99%

Melatonin and the Prevention and Management of Delirium: A Scoping Study

et al. 2018

View full text Add to dashboard Cite

BackgroundThe therapeutic benefit of melatonin in the prevention and treatment of delirium is uncertain.ObjectiveTo perform a scoping study to describe the existing literature regarding the use of melatonin and ramelteon in the prevention and treatment of delirium.MethodsWe performed a scoping study using the Arksey and O’Malley framework to explore our objective. Two independent panels searched MEDLINE, OVID, EMBASE, PubMed, Google Scholar, and Cochrane Library for relevant articles up to November 2017 describing the use of melatonin and ramelteon in the prevention or management of delirium. We extracted relevant summary data from the studies and attempted to draw conclusion regarding benefit.ResultsWe summarized evidence from 20 relevant articles. There were a total of nine articles: five randomized controlled trials (RCTs), two retrospective medical record reviews, one non-randomized observational study, and one case report describing the role of either melatonin or ramelteon in preventing delirium. There were a total of 11 studies studying the role of either melatonin or ramelteon in the management of established delirium. None of these were RCT and were predominantly case series and case reports. Four of the five trials studying the effect of melatonin analogs in preventing delirium reported a beneficial effect but study heterogeneity limited any broad recommendations. Similarly, the lack of any well-designed trials limits any recommendations regarding the effect of melatonin analogs in treating delirium.ConclusionLarge, well-designed clinical trials are required to explore the potential beneficial effects of melatonin and ramelteon on delirium prevention and management.

show abstract

“…A 2017 RCT reported that preoperative oral melatonin supplementation might improve early POCD in elderly patients undergoing hip arthroplasty, suggesting that the restoration of normal circadian function with good sleep quality may be a key factor in preventing or treating POCD [163].…”

Section: Postoperative Cognitive Dysfunctionmentioning

confidence: 99%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

View full text Add to dashboard Cite

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

show abstract

The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty: A randomized controlled trial

Cited by 51 publications

References 23 publications

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

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

Melatonin and the Prevention and Management of Delirium: A Scoping Study

Anesthetic management of geriatric patients

Contact Info

Product

Resources

About