Postoperative Cognitive Dysfunction after Noncardiac Surgery

2007 ◽  
Vol 106 (3) ◽  
pp. 572-590 ◽  
Author(s):  
Stanton Newman ◽  
Jan Stygall ◽  
Shashivadan Hirani ◽  
Shahzad Shaefi ◽  
Mervyn Maze ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Neuropsychological Tests ◽  
Significant Proportion ◽  
Postoperative Cognitive Dysfunction ◽  
The Elderly ◽  
Noncardiac Surgery ◽  
Different Types ◽  
The Status ◽  
Minimal Evidence

This article describes a systematic review on the research into postoperative cognitive dysfunction (POCD) in noncardiac surgery to ascertain the status of the evidence and to examine the methodologies used in studies. The review demonstrated that in the early weeks after major noncardiac surgery, a significant proportion of people show POCD, with the elderly being more at risk. Minimal evidence was found that patients continue to show POCD up to 6 months and beyond. Studies on regional versus general anesthesia have not found differences in POCD. Many studies were found to be underpowered, and a number of other methodologic difficulties were identified. These include the different types of surgery in studies and variations in the number and range of neuropsychological tests used. A particular issue is the variety of definitions used to classify individuals as having POCD.

Develop a Clinical Prediction Model for Postoperative Cognitive Dysfunction after Major Noncardiac Surgery in Elderly Patients: A Protocol for a Prospective Observational Study

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Yang Shen ◽  
Xianchen Li ◽  
Junyan Yao
Keyword(s):  
Observational Study ◽  
Prediction Model ◽  
Cognitive Decline ◽  
Cognitive Dysfunction ◽  
Prospective Observational Study ◽  
Postoperative Cognitive Dysfunction ◽  
Noncardiac Surgery ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Postoperative Cognitive Decline

Perioperative neurocognitive disorders (PNDs) refer to cognitive decline identified in the preoperative or postoperative period. It has been reported that the incidence of postoperative neurocognitive impairment after noncardiac surgery in patients older than 65 at 1 week was 25.8∼41.4%, and at 3 months 9.9∼12.7%. PNDs will last months or even develop to permanent dementia, leading to prolonged hospital stays, reduced quality of life, and increased mortality within 1 year. Despite the high incidence and poor prognosis of PNDs in the aged population, no effective clinical prediction model has been established to predict postoperative cognitive decline preoperatively. To develop a clinical prediction model for postoperative neurocognitive dysfunction, a prospective observational study (Clinical trial registration number: ChiCTR2000036304) will be performed in the Shanghai General Hospital during January 2021 to October 2022. A sample size of 675 patients aged &#x3e;65 years old, male or female, and scheduled for elective major noncardiac surgery will be recruited. A battery of neuropsychological tests will be used to test the cognitive function of patients at 1 week, 1 month, and 3 months postoperatively. We will evaluate the associations of PNDs with a bunch of candidate predictors including general characteristics of patients, blood biomarkers, indices associated with anesthesia and surgery, retinal nerve-fiber layer thickness, and frailty index to develop the clinical prediction model by using multiple logistic regression analysis and least absolute shrinkage and the selection operator (LASSO) method. The <i>k</i>-fold cross-validation method will be utilized to validate the clinical prediction model. In conclusion, this study was aimed to develop a clinical prediction model for postoperative cognitive dysfunction of old patients. It is anticipated that the knowledge gained from this study will facilitate clinical decision-making for anesthetists and surgeons managing the aged patients undergoing noncardiac surgery.

scholarly journals Does propofol ameliorate occurrence of postoperative cognitive dysfunction after general anaesthesia? A protocol of systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Xi Zhao ◽  
Ze-qing Huang
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Short Term Memory ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
China National Knowledge Infrastructure

Abstract Background Postoperative cognitive dysfunction (POCD) is a common condition after general anesthesia (GA). Previous studies have reported that propofol can ameliorate the occurrence of such disorder. However, its results are still inconsistent. Therefore, this systematic review will assess the efficacy and safety of propofol on POCD after GA. Methods Literature sources will be sought from inception to the present in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) assessing the administration of propofol on POCD after GA. All searches will be carried out without limitations to language and publication status. Outcomes comprise of cognitive impairments changes, impairments in short-term memory, concentration, language comprehension, social integration, quality of life, and adverse events. Cochrane risk of bias tool will be utilized to assess study quality. We will evaluate the quality of evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis or a meta-analysis will be undertaken as appropriate. Discussion This study will systematically and comprehensively search literature and integrate evidence on the efficacy and safety of propofol on POCD after GA. Our findings will be of interest to clinicians and health-related policy makers. Systematic review registration PROSPERO CRD42020164096

scholarly journals Incidence of Postoperative Cognitive Dysfunction Following Inhalational Vs. Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis.

2022 ◽  
Author(s):  
Daniel Negrini ◽  
Andrew Wu ◽  
Atsushi Oba ◽  
Ben Harnke ◽  
Nicholas Ciancio ◽  
...  
Keyword(s):  
Systematic Review ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Primary Objective ◽  
Intravenous Anesthesia ◽  
Robust Designs ◽  
Secondary Objective ◽  
Intravenous General Anesthesia

Abstract Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, i.e., evaluations up to 30 days postoperative, and neurocognitive disorder, i.e., assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1,913 articles yielded 12 studies with a total of 3,639 individuals. For the secondary objective, five studies with a total of 751 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.60 (95% CI = 0.40 - 0.91; p = 0.02), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Giving the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.

Cognitive dysfunction and sleep disorders

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Cognitive Dysfunction ◽  
Inflammatory Responses ◽  
Postoperative Cognitive Dysfunction ◽  
The Elderly ◽  
Sleep Apnoea ◽  
Sleep Stages ◽  
Anticholinergic Drugs ◽  
Obstructive Sleep ◽  
Patient’S History ◽  
The Impact

Cognitive dysfunction is largely a problem in the elderly, but it can occur at any age. The two major presentations, delirium and postoperative cognitive dysfunction (POCD), are compared. Risks for delirium are explored; key points from the patient’s history and possible ways to ameliorate the onset are then reviewed. The presentation of POCD is described, and the lack of our understanding of its causes is highlighted. Known triggers such as centrally active anticholinergic drugs or pain are identified. Current thinking in the inflammatory responses within microglia and astrocytes is summarized. Sleep in the elderly is contrasted with that in younger persons, and the main stages of sleep, SWS and REM, described. The impact and importance of the effects that surgery/anaesthesia has on sleep stages is reviewed. Obstructive sleep apnoea is described, including its effect on the safety of anaesthesia and recovery. Periodic limb movement disorders and early Parkinson disease are described.

Postoperative cognitive dysfunction in the elderly

The Lancet ◽  
1998 ◽  
Vol 351 (9119) ◽  
pp. 1889 ◽  
Author(s):  
Jakob Trier Moller ◽  
Lars S Rasmussen ◽  
Chris Hanning
Keyword(s):  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
The Elderly
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