Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients.

Details

Serval ID
serval:BIB_26DA65BC1A18
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients.
Journal
Anesthesia and Analgesia
Author(s)
Rossi A., Burkhart C., Dell-Kuster S., Pollock B.G., Strebel S.P., Monsch A.U., Kern C., Steiner L.A.
ISSN
1526-7598 (Electronic)
ISSN-L
0003-2999
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
119
Number
4
Pages
947-955
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
BACKGROUND: Cerebral cholinergic transmission plays a key role in cognitive function, and anticholinergic drugs administered during the perioperative phase are a hypothetical cause of postoperative cognitive dysfunction (POCD). We hypothesized that a perioperative increase in serum anticholinergic activity (SAA) is associated with POCD in elderly patients.
METHODS: Seventy-nine patients aged >65 years undergoing elective major surgery under standardized general anesthesia (thiopental, sevoflurane, fentanyl, and atracurium) were investigated. Cognitive functions were assessed preoperatively and 7 days postoperatively using the extended version of the CERAD-Neuropsychological Assessment Battery. POCD was defined as a postoperative decline >1 z-score in at least 2 test variables. SAA was measured preoperatively and 7 days postoperatively at the time of cognitive testing. Hodges-Lehmann median differences and their 95% confidence intervals were calculated for between-group comparisons.
RESULTS: Of the patients who completed the study, 46% developed POCD. Patients with POCD were slightly older and less educated than patients without POCD. There were no relevant differences between patients with and without POCD regarding gender, demographically corrected baseline cognitive functions, and duration of anesthesia. There were no large differences between patients with and without POCD regarding SAA preoperatively (pmol/mL, median [interquartile range]/median difference [95% CI], P; 1.14 [0.72, 2.37] vs 1.13 [0.68, 1.68]/0.12 [-0.31, 0.57], P = 0.56), SAA 7 days postoperatively (1.32 [0.68, 2.59] vs 0.97 [0.65, 1.83]/0.25 [-0.26, 0.81], P = 0.37), or changes in SAA (0.08 [-0.50, 0.70] vs -0.02 [-0.53, 0.41]/0.1 [-0.31, 0.52], P = 0.62). There was no significant relationship between changes in SAA and changes in cognitive function (Spearman rank correlation coefficient preoperatively of 0.03 [95% CI, -0.21, 0.26] and postoperatively of -0.002 [95% CI, -0.24, 0.23]).
CONCLUSIONS: In this panel of patients with low baseline SAA and clinically insignificant perioperative anticholinergic burden, although a relationship cannot be excluded in some patients, our analysis suggests that POCD is probably not a substantial consequence of anticholinergic medications administered perioperatively but rather due to other mechanisms.
Keywords
Aged, Anesthesia, General/adverse effects, Cholinergic Antagonists/blood, Cognition Disorders/blood, Cognition Disorders/diagnosis, Elective Surgical Procedures/adverse effects, Female, Humans, Male, Neuropsychological Tests, Postoperative Complications/blood, Postoperative Complications/diagnosis
Pubmed
Web of science
Create date
20/01/2015 18:42
Last modification date
20/08/2019 13:05
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