Should EEG waveform characteristics of BIS may be informative to detect brain fragility and to predict postoperative cognitive dysfunction? A homozygous twins case report

Abstract Background: Besides inducing behavioral unresponsiveness, a key goal of anesthesia is to prevent the experience of surgery (connected consciousness) by inducing either unconsciousness or disconnection of consciousness from the environment. In pursuing this key goal, avoiding the risk of postoperative cognitive dysfunction is also necessary. In this case report we relate electroencephalography waveform characteristics during intraoperative bispectral index monitoring to long-term neurocognitive decline. Case presentation: We describe the case of two 68-year-old homozygous twins who underwent the same general anaesthesia regimen, but had different results on neurocognitive testing 12 months postoperatively. Neurocognitive tests (Montreal Cognitive Assessment, Trail Making Test A and B, Digit Span Test, and Frontal Assessment Battery) were performed in three different times: the day before surgery, the third day postoperatively, and 12 months after surgery for follow-up. During anaesthesia, connected consciousness and anaesthesia depth were monitored using the isolated forearm technique and bispectral index monitoring. The mean value of bispectral index was lower in one twin (S1) than in the other (S2). Moreover, the same twin who presented lower values of bispectral index had two episodes of burst suppression, whereas the other had none. Regarding the neurocognitive evaluations, both twins did not show significative differences between the tests performed before and after surgery, but an important difference was founded at the 12-month follow-up, when only one twin (S1) showed distinctly worse test scores than previous, denoting a significant cognitive decline. Conclusions: This case-report suggests that bispectral index electroencephalography waveform characteristics during intraoperative bispectral index monitoring may be useful in detecting brain’s susceptibility to general anaesthesia and in predicting long-term neurocognitive decline.

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Case Studies of Postoperative Cognitive Dysfunction in Elderly Patients

10.31487/j.ijcst.2021.03.02 ◽

2021 ◽

pp. 1-5

Author(s):

Kalliopi Megari ◽

Kalliopi Megari

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Cognitive Dysfunction ◽

Critical Role ◽

Postoperative Cognitive Dysfunction ◽

Verbal Working Memory ◽

Short Term

Background and Objective: Postoperative cognitive dysfunction (POCD) involves decline in several cognitive domains after surgery and is particularly common after cardiac surgery. Given the potential effects of such cognitive dysfunction on quality of life, it is important to study it in multiple populations in order to limit its occurrence. Recent advances in surgical technology may assist in achieving this goal. Methods: We present the long-term neuropsychological outcome of two elderly patients, one of whom had off pump heart surgery and the other oncological surgery. We administered a series of neuropsychological tests assessing attention, complex scanning, verbal working memory, executive functioning, short-term and long-term memory, and visuospatial perception before surgery, prior to discharge, at 3-month follow-up and 6 years after surgery. We compared the performance of these two patients to normative datasets. Results: Despite equivalent levels of pre-surgery performance between the two patients, the oncology patient exceeded his preoperative neurocognitive levels, suggesting less postoperative cognitive dysfunction in the heart patient overall, on all neuropsychological domains at 6-year follow-up, except short-term retention. In contrast, the heart patient showed no improvement, and, instead, showed some cognitive decline which remained consistent over time. Conclusion: Our findings highlight the critical role of the type of surgery utilized in the development of POCD and have implications for clinical management and patients’ quality of life in the very long term.

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Postoperative Cognitive Dysfunction

Anesthesiology: A Problem-Based Learning Approach ◽

10.1093/med/9780190850692.003.0051 ◽

2018 ◽

pp. 449-454

Author(s):

Wael Saasouh ◽

Shobana Rajan

Keyword(s):

Cognitive Function ◽

Early Detection ◽

Cognitive Dysfunction ◽

Surgical Procedure ◽

Postoperative Cognitive Dysfunction ◽

Short Term ◽

Related Cost ◽

Postoperative Setting

Postoperative cognitive dysfunction (POCD) is an underdiagnosed serious complication occurring after a surgical procedure. It carries risks for short-term and long-term complications and may predispose an individual to a multitude of morbidities, increased healthcare-related cost, as well as death. Prevention of POCD is the most important step in avoiding morbidity, and steps to minimize its effect include early detection, proper management, and diligent follow-up. This chapter discusses, among other issues, measurement and examination of POCD, cognitive function in the preoperative and postoperative setting, intraoperative factors that influence POCD, complications of POCD, and strategies to protect patients against POCD.

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Association of apolipoprotein ε4 with postoperative cognitive dysfunction and long-term memory in elderly patients undergoing general anesthesia

10.26226/morressier.57108e2cd462b80290b49d88 ◽

2016 ◽

Author(s):

Livia Valentin

Keyword(s):

Elderly Patients ◽

General Anesthesia ◽

Cognitive Dysfunction ◽

Postoperative Cognitive Dysfunction ◽

Long Term Memory ◽

Term Memory

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Faculty Opinions recommendation of Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1040752.489787 ◽

2006 ◽

Author(s):

Valerie Billard

Keyword(s):

Cognitive Dysfunction ◽

Bispectral Index ◽

Postoperative Cognitive Dysfunction ◽

Depth Of Anesthesia

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Long-Term Effects of Resistance Training on body Composition, Physical Fitness and Bone Mineral Density in a Osteopenia Elderly Woman : A Case Report with 3-Year Follow-Up

The Korean Journal of Growth and Development ◽

10.34284/kjgd.2018.02.26.1.111 ◽

2018 ◽

Vol 26 (1) ◽

pp. 111-117

Author(s):

Seon-young Lee ◽

Sang-won Seo ◽

Sang-hyup Song ◽

Ho-seong Lee

Keyword(s):

Bone Mineral Density ◽

Body Composition ◽

Case Report ◽

Resistance Training ◽

Physical Fitness ◽

Elderly Woman ◽

Long Term Effects ◽

Mineral Density

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Brain Abscess Caused by Nocardia: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1719124 ◽

2020 ◽

Author(s):

Guilherme Finger ◽

Maria Eduarda Conte Gripa ◽

Tiago Paczko Bozko Cecchini ◽

Tobias Ludwig do Nascimento

Keyword(s):

Case Report ◽

Antibiotic Therapy ◽

Brain Abscess ◽

Clinical Signs ◽

Occipital Lobe ◽

High Morbidity ◽

Rare Clinical Entity ◽

Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

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Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00202 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Michael Ryan ◽

Benton Emblom ◽

E. Lyle Cain ◽

Jeffrey Dugas ◽

Marcus Rothermich

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Failure Rate ◽

Osteochondritis Dissecans ◽

Surgical Techniques ◽

The Other ◽

Return To Play ◽

Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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