The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis

Bhushan, Shanti; Huang, Xin; Duan, Yuanqiong; Xiao, Zhi

doi:10.1016/j.ijsu.2022.106854

Cited by 56 publications

(25 citation statements)

References 44 publications

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“…In both experiments, no significant decrease in human cognitive ability was observed due to short-term propofol anesthesia exposure (Chinn et al, 2016). A meta-analysis showed that at 24 h, 3 days and 7 days after hip surgery, propofol could cause minimal changes in cognitive function (Bhushan et al, 2022). However, when using single anesthetic propofol for cystoscopy or hysteroscopy, the incidence of cognitive dysfunction in elderly patients (≥73 years old) after surgery on the first day was 47% (Rohan et al, 2005).…”

Section: Propofolmentioning

confidence: 89%

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

Chen

Wang²,

ZhaoQian³

et al. 2023

Front. Neurosci.

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Cognitive disorders are mental health disorders that can affect cognitive ability. Surgery and anesthesia have been proposed to increase the incidence of cognitive dysfunction, including declines in memory, learning, attention and executive function. Tau protein is a microtubule-associated protein located in the axons of neurons and is important for microtubule assembly and stability; its biological function is mainly regulated by phosphorylation. Phosphorylated tau protein has been associated with cognitive dysfunction mediated by disrupting the stability of the microtubule structure. There is an increasing consensus that anesthetic drugs can cause cognitive impairment. Herein, we reviewed the latest literature and compared the relationship between tau protein and cognitive impairment caused by different anesthetics. Our results substantiated that tau protein phosphorylation is essential in cognitive dysfunction caused by anesthetic drugs, and the possible mechanism can be summarized as “anesthetic drugs-kinase/phosphatase-p-Tau-cognitive impairment”.

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Section: Propofolmentioning

confidence: 89%

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

Chen

Wang²,

ZhaoQian³

et al. 2023

Front. Neurosci.

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“…Most general anesthesia drugs will affect the central nervous system of patients. 20 Moreover, the trauma caused by tumor surgery is also relatively large, which may cause the stress response and abnormal hemodynamic indexes, thus affecting brain oxygen metabolism. 21 CERO2 is closely related to cerebral blood flow and the balance of cerebral oxygen supply and demand.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Different Anesthesia Depths on Postoperative Cognitive Function of Tumor Patients Monitored by Narcotrend

Zhao,

Guo,

et al. 2024

J Neurol Surg B Skull Base

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Objectives The study aimed to examine the influence of different anesthesia depths monitored by Narcotrend on postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of gastrointestinal malignancies. Methods Individuals in the control group (n = 40) maintained the Narcotrend index (NTI) at 50 to 59 monitored by Narcotrend, whereas the experimental group at 30 to 39. The mini-mental state examination (MMSE) scale and serum S100β concentration were used to evaluate the cognitive function. Cerebral oxygen metabolism and inflammation were evaluated, presenting as regional oxygen saturations of brain (rSO2) and cerebral oxygen uptake rate (CERO2), serum tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Results Experimental group presented prominently high levels of rSO2 and low levels of CERO2 relative to controls, meanwhile with reduced serum TNF-α and IL-6. Individuals receiving deep anesthesia owned low levels of S100β and enhanced MMSE score, which showed negative correlation. Low incidence rate of POCD was detected in the experimental group. Both age (hazard ratio = 5.219, 95% confidence interval = 1.813–15.025) and NTI score (hazard ratio = 3.707, 95% confidence interval = 1.292–10.633) were independent influence factors for the onset of POCD. Conclusion NTI maintained at 30 to 39 can reduce the incidence of POCD in the early postoperative period for elderly patients receiving gastrointestinal tumors surgery, the contribution might be attributed to the improvement of perioperative cerebral oxygen metabolism and inflammatory stress response.

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“…( 40 ). However, it’s worth noting that another meta-analysis yielded contradictory results, indicating no statistically significant difference in the incidence of postoperative delirium between regional anesthesia and general anesthesia ( 41 ). But, this study is subject to considerable heterogeneity influenced by multiple factors.…”

Section: Discussionmentioning

confidence: 99%

Effect of thoracic paravertebral nerve block on delirium in patients after video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials

Zhou,

Mao,

Zhao

et al. 2024

Front. Neurol.

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BackgroundNerve blocks are widely used in various surgeries to alleviate postoperative pain and promote recovery. However, the impact of nerve block on delirium remains contentious. This study aims to systematically evaluate the influence of Thoracic Paravertebral Nerve Block (TPVB) on the incidence of delirium in patients post Video-Assisted Thoracoscopic Surgery (VATS).MethodsWe conducted a systematic search of PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases in June 2023. The search strategy combined free-text and Medical Subject Headings (MeSH) terms, including perioperative cognitive dysfunction, delirium, postoperative cognitive dysfunction, paravertebral nerve block, thoracic surgery, lung surgery, pulmonary surgery, and esophageal/esophagus surgery. We utilized a random effects model for the analysis and synthesis of effect sizes.ResultsWe included a total of 9 RCTs involving 1,123 participants in our study. In VATS, TPVB significantly reduced the incidence of delirium on postoperative day three (log(OR): −0.62, 95% CI [−1.05, −0.18], p = 0.01, I2 = 0.00%) and postoperative day seven (log(OR): −0.94, 95% CI [−1.39, −0.49], p < 0.001, I2 = 0.00%). Additionally, our study indicates the effectiveness of TPVB in postoperative pain relief (g: −0.82, 95% CI [−1.15, −0.49], p < 0.001, I2 = 72.60%).ConclusionThe comprehensive results suggest that in patients undergoing VATS, TPVB significantly reduces the incidence of delirium and notably diminishes pain scores.Systematic review registrationCRD42023435528. https://www.crd.york.ac.uk/PROSPERO.

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The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis

Cited by 56 publications

References 44 publications

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

The Effect of Different Anesthesia Depths on Postoperative Cognitive Function of Tumor Patients Monitored by Narcotrend

Effect of thoracic paravertebral nerve block on delirium in patients after video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials

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