scholarly journals Cerebral Oximetry and Cognitive Dysfunction in Elderly Patients Undergoing Surgery for Hip Fractures: A Prospective Observational Study

2012 ◽  
Vol 6 (1) ◽  
pp. 400-405 ◽  
Author(s):  
George Papadopoulos ◽  
Menelaos Karanikolas ◽  
Antonia Liarmakopoulou ◽  
George Papathanakos ◽  
Marianna Korre ◽  
...  
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Cognitive Dysfunction ◽  
Hip Fractures ◽  
Prospective Observational Study ◽  
Mmse Score ◽  
Postoperative Cognitive Dysfunction ◽  
Cerebral Oximetry ◽  
Hospital Length Of Stay

Aim: This study was conducted to examine perioperative cerebral oximetry changes in elderly patients undergoing hip fracture repair and evaluate the correlation between regional oxygen saturation (rSO2) values, postoperative cognitive dysfunction (POCD) and hospital stay. Materials and Methods: This prospective observational study included 69 patients. Data recorded included demographic information, rSO2 values from baseline until the second postoperative hour and Mini Mental State Examination (MMSE) scores preoperatively and on postoperative day 7. MMSE score ≤23 was considered evidence of cognitive dysfunction. Postoperative confusion or agitation, medications administered for postoperative agitation, and hospital length of stay were also recorded. Data were analyzed with Student’s t-test, Pearson’s correlation or multiple regression analysis as appropriate. Results: Patient age was 74±13 years. Baseline left sided rSO2 values were 60±10 and increased significantly after intubation. Baseline rSO2 L<50 and <45 was observed in 11.6% and 10.1% of patients respectively. Perioperative cerebral desaturation occurred in 40% of patients. MMSE score was 26.23 ± 2.77 before surgery and 25.94 ± 2.52 on postoperative day 7 (p=0.326). MMSE scores ≤ 23 were observed preoperatively in 6 and postoperatively in 9 patients. Patients with cognitive dysfunction had lower preoperative hematocrit, hemoglobin, SpO2 and rSO2 values at all times, compared to patients who did not. There was no correlation between rSO2 or POCD and hospital stay. Patients with baseline rSO2 <5 required more medications for postoperative agitation. Conclusion: Cognitive dysfunction occurs preoperatively and postoperatively in elderly patients with hip fractures, and is associated with low cerebral rSO2 values.

Baseline cerebral oximetry values in elderly patients with hip fractures: A prospective observational study

Injury ◽  
2011 ◽  
Vol 42 (11) ◽  
pp. 1328-1332 ◽  
Author(s):  
Georgios Papadopoulos ◽  
Menelaos Karanikolas ◽  
Antonia Liarmakopoulou ◽  
Alexandros Berris
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Prospective Observational Study ◽  
Cerebral Oximetry

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.

Cerebral oximetry during preoperative resuscitation in elderly patients with hip fracture: a prospective observational study

2018 ◽  
Vol 32 (6) ◽  
pp. 1033-1040 ◽  
Author(s):  
C. G. Clemmesen ◽  
L. M. Pedersen ◽  
S. Hougaard ◽  
M. L. Andersson ◽  
V. Rosenkvist ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Cerebral Oximetry

scholarly journals Association between the Apolipoprotein E4 and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Intravenous Anesthesia and Inhalation Anesthesia

2012 ◽  
Vol 116 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Yingmin Cai ◽  
Haitao Hu ◽  
Pengbin Liu ◽  
Gaifeng Feng ◽  
Weijiang Dong ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Elderly Patients ◽  
Apolipoprotein E ◽  
Cognitive Dysfunction ◽  
Mmse Score ◽  
Postoperative Cognitive Dysfunction ◽  
Intravenous Anesthesia ◽  
Inhalation Anesthesia ◽  
Anesthesia Group ◽  
Ε4 Allele

Background Intravenous and inhalation anesthesia are commonly used in the clinical setting. Recovery of cognitive function in elderly patients after surgery has received increased attention. In this study, the authors compared recovery of cognitive function in patients after different anesthesia techniques, and investigated which technique is safer. The authors also explored association between apolipoprotein E4 and postoperative cognitive dysfunction in patients undergoing general anesthesia. Methods A total of 2,000 patients were equally and randomly divided into intravenous and inhalation anesthesia groups. Total intravenous and inhalation anesthesia were used. Within 10 days after surgery, cognitive function was assessed daily using the Mini-Mental State Examination (MMSE). Restriction fragment length polymorphism of apolipoprotein E gene was analyzed. The primary outcome was MMSE score, frequency distribution of apolipoprotein E alleles and genotypes. P &lt; 0.01 was used as statistically significant. Results MMSE score in inhalation preoperative baseline group significantly decreased at day 3 after surgery compared with the preoperational and intravenous anesthesia group. The proportion of patients scoring less than 25 points was significantly greater in the inhalation anesthesia group than in the intravenous anesthesia group at 3 days after surgery. In the inhalation anesthesia group, the decrease in MMSE score was closely related with apolipoprotein E ε4 allele. In the intravenous anesthesia group, the decrease in MMSE score was not correlated with apolipoprotein E ε4 allele. Conclusions There was a strong association between the apolipoprotein E ε4 and postoperative cognitive dysfunction in elderly patients undergoing inhalation anesthetics.

scholarly journals Dynamic Change of Lymphocyte-to-Monocyte Is Associated With the Occurrence of POCD After Cardiovascular Surgery: A Prospective Observational Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Qi Zhao ◽  
Rui Gao ◽  
Changliang Liu ◽  
Hai Chen ◽  
Xueying Zhang ◽  
...  
Keyword(s):  
Observational Study ◽  
Cognitive Dysfunction ◽  
Roc Curve ◽  
Prospective Observational Study ◽  
Cardiovascular Surgery ◽  
Dynamic Change ◽  
Postoperative Cognitive Dysfunction ◽  
Monocyte Count ◽  
Cutoff Value ◽  
Group A

Objective: Postoperative cognitive dysfunction (POCD) is a common and severe complication of cardiovascular surgery. Lymphocyte-to-monocyte ratio (LMR) has been reported to be an independent predictor of lots of diseases associated with inflammation, but the association between the LMR and POCD is not clear. The present study aimed to investigate the potential value of LMR level to predict POCD in patients undergoing cardiovascular surgery.Methods: A prospective observational study was performed on the patients diagnosed with heart diseases undergoing cardiovascular surgeries with cardiopulmonary bypass. The leukocyte counts were measured by blood routine examination preoperatively. Then we calculated the LMR by dividing the lymphocyte count by the monocyte count. Neurocognitive functions were assessed 1 day before and 7 days after surgery. Perioperative factors were recorded to explore the relationship between LMR and POCD.Results: In total, 75 patients finished the whole study, while 34 patients developed POCD. The preoperative LMR level in the POCD group was higher than that in the non-POCD group. A cutoff value of 4.855 was identified to predict POCD occurrence according to ROC curve. The perioperative dynamic change of LMR level in the POCD group was higher than those in the non-POCD group. A cutoff value of 2.255 was identified to predict POCD occurrence according to ROC curve and the dynamic LMR change had similar varying trend with preoperative LMR level.Conclusions: The dynamic change of LMR level in the peripheral blood is associated with occurrence of POCD, and preoperative LMR level seems to be a prognostic biomarker of postoperative cognitive dysfunction in patients after cardiovascular surgery.

scholarly journals Safety of High-Dose Dabigatran in Elderly and Younger Patients with a Low Bleeding Risk: A Prospective Observational Study

Cardiology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Aharon Erez ◽  
Gregory Golovchiner ◽  
Robert Klempfner ◽  
Ehud Kadmon ◽  
Gustavo Ruben Goldenberg ◽  
...  
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Bleeding Risk ◽  
The Elderly ◽  
High Dose ◽  
World Population ◽  
Younger Patients ◽  
End Point

<b><i>Introduction:</i></b> In patients with atrial fibrillation (AF) at risk for stroke, dabigatran 150 mg twice a day (DE150) is superior to warfarin for stroke prevention. However, there is paucity of data with respect to bleeding risk at this dose in elderly patients (≥75 years). We aimed to evaluate the safety of DE150 in comparison to warfarin in a real-world population with AF and low bleeding risk (HAS-BLED score ≤2). <b><i>Methods:</i></b> In this prospective observational study, 754 consecutive patients with AF and HAS-BLED score ≤2 were included. We compared outcome of elderly patients (age ≥75 tears) to younger patients (age &#x3c;75 years). The primary end point was the combined incidence of all-cause mortality, stroke, systemic emboli, and major bleeding event during a mean follow-up of 1 year. <b><i>Results:</i></b> There were 230 (30%) elderly patients, 151 patients were treated with warfarin, and 79 were treated with DE150. Fifty-two patients experienced the primary endpoint during the 1-year follow-up. Among the elderly, at 1-year of follow-up, the cumulative event rate of the combined endpoint in the DE150 and warfarin was 8.9 and 15.9% respectively (<i>p</i> = 0.14). After adjustment for age and gender, patients who were treated with DE150 had a nonsignificant difference in the risk for the combined end point as patients treated with warfarin both among the elderly and among the younger population (HR 0.58, 95% C.I = 0.25–1.39 and HR = 1.12, 95% C.I 0.62–2.00, respectively [<i>p</i> for age-group-by-treatment interaction = 0.83). <b><i>Conclusions:</i></b> Our results suggest that Dabigatran 150 mg twice a day can be safely used among elderly AF patients with low bleeding risk.

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