scholarly journals Comparison of postoperative cognitive dysfunction with the use of propofol versus desflurane in patients undergoing surgery for clipping of aneurysm after subarachnoid hemorrhage

2020 ◽  
Vol 11 ◽  
pp. 174
Author(s):  
Nanish Sharma ◽  
Jyotsna Wig ◽  
Shalvi Mahajan ◽  
Rajeev Chauhan ◽  
Manju Mohanty ◽  
...  
Keyword(s):  
Executive Function ◽  
Subarachnoid Hemorrhage ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Postoperative Cognitive Dysfunction ◽  
Aneurysm Rupture ◽  
Double Blind ◽  
Anesthetic Agents ◽  
Number Of Patients ◽  
Brain Relaxation

Background: Cerebral aneurysm rupture is a distinct entity among various causes of cerebrovascular accident. Despite the current concept of early surgical clipping to prevent consequences of ruptured aneurysm in good grade subarachnoid hemorrhage patients, 40–50% have postoperative cognitive dysfunction (POCD) on a long- term basis. Here, we compared the effect of two commonly used anesthetic agents on cognitive function following cerebral aneurysmal surgery, i.e., propofol and desflurane. Methods: We conducted a prospective double-blind clinical study in 70 patients who were randomized to receive maintenance anesthetic agents either propofol or desflurane. The cognitive functions of patients were studied at the time of the discharge from a hospital or at 2 weeks following surgery whichever was early using the Hindi version of the Montreal Cognitive Assessment scale. The hemodynamic parameters, brain relaxation score at the different time intervals, were also studied. Results: There was no difference between the two anesthetic agents in terms of incidence of POCD (65.4% vs. 82.6%, P > 0.05) at the time of discharge or at 2 weeks following surgery. The mean POCD score in propofol and desflurane group was 22.81 ± 4.45 and 19.09 ± 5.66 which was statistically significant (P-value-0.01). The scores for domains of executive function, attention, and orientation were better with propofol group than desflurane group. Intraoperative hemodynamics and brain relaxation scores were similar in both groups. Conclusion: A significant number of patients undergoing aneurysmal neck surgery experienced POCD although incidence remained similar in both groups. However, it appears that mean cognitive score and certain domains of cognitive functions especially the executive function, attention, and orientation were better preserved with the use of propofol when compared to desflurane at the time of discharge or on 2 weeks following surgery whichever was early.

scholarly journals Effect of Sugammadex versus Neostigmine/Atropine Combination on Postoperative Cognitive Dysfunction after Elective Surgery

2017 ◽  
Vol 45 (5) ◽  
pp. 581-588 ◽  
Author(s):  
C. Batistaki ◽  
M. Riga ◽  
F. Zafeiropoulou ◽  
G. Lyrakos ◽  
G. Kostopanagiotou ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Elective Surgery ◽  
Neuromuscular Block ◽  
Controlled Trial ◽  
Postoperative Cognitive Dysfunction ◽  
Random Allocation ◽  
Double Blind ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test

This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years of age. The Mini–Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block reversal, which was administered by random allocation using either sugammadex or neostigmine/ atropine after the reappearance of T2 in the train-of-four sequence. POCD was defined as a decline ≥1 standard deviation in ≥2 cognitive tests. The incidence of POCD was similar in both groups at one hour postoperatively and at discharge (28% and 10%, in the neostigmine group, 23% and 5.4% in the sugammadex group, P=0.55 and 0.27 respectively). In relation to individual tests, a significant decline of clock-drawing test in the neostigmine group was observed at one hour postoperatively and at discharge. For the Isaacs Set test, a greater decline was found in the sugammadex group. These findings suggest that there are no clinically important differences in the incidence of POCD after neostigmine or sugammadex administration.

scholarly journals Effects of Chronic L-theanine on Stress-related Symptoms and Cognitive Function in a Non-clinical Population: A Randomized Controlled Trial (P06-106-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Hiroshi Kunugi ◽  
Shinsuke Hidese ◽  
Shintaro Ogawa ◽  
Miho Ota ◽  
Zenta Yasukawa ◽  
...  
Keyword(s):  
Executive Function ◽  
Placebo Group ◽  
Crossover Study ◽  
Cognitive Functions ◽  
Controlled Trial ◽  
Depression Scale ◽  
Clinical Population ◽  
Double Blind ◽  
Funding Sources ◽  
Brief Assessment

Abstract Objectives This randomized, placebo-controlled, and double-blind, crossover study aimed to investigate the effects of chronic L-theanine (Suntheanine®) administration on stress-related symptoms and cognitive functions in a non-clinical population. Methods Participants were 9 men and 21 women (mean age: 48.3 ± 11.9 years) who had no psychiatric illness of clinical level. L-theanine (200 mg/day) or placebo tablets were randomly assigned to participants for 4 weeks administration. After 2 weeks of wash-out period, the crossover study was continued for 4 weeks. Stress related symptoms were assessed using Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Pittsburgh Sleep Quality Index (PSQI). Cognitive functions were assessed with Brief Assessment of Cognition in Schizophrenia (BACS). Results SDS, STAI-trait, and PSQI scores significantly decreased after 4 weeks of L-theanine administration, while there were no significant changes after placebo. Verbal fluency and executive function scores of BACS significantly increased (p = 0.001 and 0.031) after L-theanine, but not placebo, administration. Changes in sleep latency, sleep disturbance, and use of sleep medication subscales of PSQI were significantly better in the L-theanine than in the placebo group. Changes in SDS and PSQI total scores also tended to be better in L-theanine than in placebo group. The rate of individuals who showed an improvement in BACS executive function score (5 or more) was significantly greater in L-theanine group than in placebo group. There was no significant adverse event after chronic L-theanine administration. Conclusions The results suggest that 4 weeks of L-theanine (200 mg/day) administration is safe and effective on stress-related symptoms and cognitive functions in a non-clinical population. Funding Sources This research was funded by Taiyo Kagaku, Co. Ltd.

Postoperative Cognitive Dysfunction

2021 ◽  
Vol 1 (3) ◽  
pp. 41-43
Author(s):  
Awang Budi Saksono
Keyword(s):  
Cognitive Impairment ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Large Body ◽  
Postoperative Cognitive Dysfunction ◽  
Anesthetic Agents ◽  
Incident Dementia ◽  
Anesthetic Considerations ◽  
The Impact

The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and the development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves or whether other variables are causative of the observed changes in understanding. Furthermore, there are conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders or incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.

scholarly journals The influence of the chosen method of anesthesia on the severity of postoperative cognitive dysfunction in patients with ophthalmic surgery

2021 ◽  
Vol 26 (1) ◽  
pp. 122-128
Author(s):  
G.S. Dorofeeva
Keyword(s):  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Short Term Memory ◽  
Clinical Symptoms ◽  
Research Work ◽  
Postoperative Cognitive Dysfunction ◽  
Blood Gases ◽  
General Anesthetics ◽  
Ophthalmic Surgery ◽  
End To End

Reduction of cognitive functions in the postoperative period is gaining importance in the context of the insurance medicine introduction. Operational stress and anaesthetization are factors which increase the risk of deepening and developing postoperative cognitive dysfunction. The function of short-term memory, attention function, and the speed of psychomotor cognitive reactions are the most vulnerable to the action of general anesthetics. The influence of various methods of anesthesia on cognitive functions in ophthalmic surgery patients after end-to-end keratoplasty has been studied in this research work. Dexmedetomidine was used (the selective agonist of α-adrenoreceptors) as one of the components of multimodal anaesthetization. The sedative effect of this drug is explained by inhibition of neural activity in the blue spot of the brain stem. Dexmedetomidine is known to be used for sedation of patients. It allowed possibility to reduce the amount of fentanyl which was necessary for intra-and post-operative anaesthetization. Our research was conducted on the basis of ME "DRCOH". 78 patients at the age of 18 to 60 years were examined after end-to-end keratoplasty. Non-inclusion criteria: presence of concomitant pathology, neurological diseases, use of psychotropic substances and alcohol 6 months before the study. The study was conducted using neuropsychological testing: the Mini Mental State Examination (MMSE),the Frontal Assessment Battery (FAB), and Luria’s test. Testing was performed before the operation, in 6, 24 hours, 7 and 21 days. Patients were randomized into two groups. The first group – group k (n1=45) included patients who were provided with anaesthetic management according to the following scheme:premedication — ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously, sibazone 10 mg, fentanyl 0.1 mg intramuscularly 40 minutes before intervention. Induction of propofol – 2-2.5 mg/kg fractionally to achieve clinical symptoms of anaesthetization, fentanyl – 0.005% 0.1 mg tracheal intubation after relaxation on the background of atracuriumbenzylate – 0.3-0.6 mg/kg. Maintaining of anaesthetization: oxygen-sevoflurane mixture FiO250-55%, sevoflurane 1,4-1,8 vol.% on exhalation (1-1. 5 WT.) with the flow of no more than 1 l/min. BIS indicators were kept at the level of 30-40, during the surgery, the bolus injection of 0.1 mg of fentanyl was used in the event of hemodynamic reactions. Anaesthetic support was performed using the infusion of dexmedetomidin for 40 minutes, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously in the second group d (n2=33). Induction, relaxation and maintenance of anaesthetization were performed as in the previous group. Intra-operative monitoring of patients in both groups included: non-invasive measurement of blood pressure (BP), heart rate (HR), pulse oximetry, determination of blood gases (oxygen, carbon dioxide and inhaled anesthetic on inhalation and exhalation). Control of the depth of anaesthetization was performed on the basis of BIS and ANI - monitoring. The use of dexmedetomidinu as the component of a multi-modal method of anaesthetizational al lowed obtaining less pronounced POCD, due to the reduction in the number of used drugs. Further use of the combination of highly selective agonists of α2-adrenoreceptors with regional anaesthetization in ophthalmic surgery is the promising method.

scholarly journals The Relationship Between Timing of Surgery and Operative Complications in Aneurysmal Subarachnoid Hemorrhage

1987 ◽  
Vol 14 (S1) ◽  
pp. 84-87 ◽  
Author(s):  
William S. Tucker
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Double Blind ◽  
Technical Problems ◽  
University Of Toronto ◽  
Surgical Technical ◽  
Aneurysm Repair

ABSTRACT:The optimal timing of definitive aneurysm repair following subarachnoid hemorrhage remains a controversial issue. In order to examine whether the timing of surgery alters the incidence of certain technical difficulties and complications associated with intracranial aneurysm repair, data from two recent co-operative studies were examined. The cases submitted to the International Co-operative Study on Timing of Aneurysm Surgery by the University of Toronto hospitals, and the cases submitted from multiple centres to the Three-Dose Multicentre Randomized Double-Blind Nimodipine Study were evaluated with regard to operative difficulties and complications, comparing early (≤ 3 days) and late (≥ 4 days) surgery following subarachnoid hemorrhage. No significant differences were found in the incidence of such technical problems between the early and late surgical groups. If differences in outcome occur between comparable groups of patients operated early and late after aneurysm rupture, factors other than surgical technical complications may be responsible.

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