Intraoperative cerebral perfusion and postoperative cognitive dysfunction in geriatric patients

Details

Serval ID
serval:BIB_047C141F41E5
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Collection
Publications
Institution
Title
Intraoperative cerebral perfusion and postoperative cognitive dysfunction in geriatric patients
Title of the conference
Annual meeting of the Swiss Society of Anaesthesiology and Resuscitation
Author(s)
Burkhart C.S., Gamberini M., Smielewski P., Monsch A.U., Strebel S.P., Steiner L.A.
Address
Interlaken, Switzerland, October 29-31, 2009
ISBN
1424-7860
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
139
Series
Swiss Medical Weekly
Pages
2S-2S
Language
english
Notes
Meeting Abstract, Supplementum 177 (Supplement to No 41-42/2009)
Abstract
Background: Inadequate intraoperative cerebral perfusion has been suggested as a possible cause of postoperative cognitive dysfunction (POCD).
Methods: We investigated 35 patients aged 65 or older undergoing elective major non-cardiac surgery under standardized general anaesthesia (thiopental, sevoflurane, fentanyl, atracurium). Intraoperative cerebral perfusion was monitored with transcranial Doppler, and near-infrared spectroscopy (NIRS). Arterial blood pressure was monitored continuously with a Finapres device. Mx, an index allowing continuous monitoring of cerebrovascular autoregulation based on the changes in mean arterial blood pressure (MAP) and cerebral blood flow velocity was calculated. Mx >0.5 was defined as disturbed cerebrovascular autoregulation. Cognitive function was measured preoperatively and 7 days postoperatively using the CERAD-NAB Plus test battery. A postoperative decline >1 z-score in at least two of the tested domains was defined as POCD. Data are shown as mean } SD.
Results: Mean age was 75 } 7 yrs. Sixteen patients (46%) developed POCD. These patients were older (77 } 8 vs 73 } 7 yrs), had lower MAP (77 } 12 vs 81 } 11 mm Hg), lower cerebral tissue oxygenation indices measured by NIRS (66.8 } 6.0 vs 68.6 } 4.3%) and less efficient cerebrovascular autoregulation (Mx 0.54 } 0.17 and 0.44 } 0.22) than patients without POCD. Disturbed intraoperative cerebrovascular autoregulation was found more often (56 vs 37%) in patients with POCD. However, none of these differences reached statistical significance. Conclusions: Our data show a trend towards subtle changes in intraoperative cerebral perfusion in elderly patients who develop POCD. However, a cause effect relationship must not be assumed and a greater number of patients needs to be investigated patients. However, more patients need to be investigated to confirm and characterize these differences.
Create date
18/11/2009 16:23
Last modification date
20/08/2019 12:26
Usage data