Postoperative cognitive dysfunction POCD, serum anticholinergic activity and intraoperative cerebral perfusion in geriatric patients

Details

Serval ID
serval:BIB_2AB892716D30
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
Postoperative cognitive dysfunction POCD, serum anticholinergic activity and intraoperative cerebral perfusion in geriatric patients
Title of the conference
EuroNeuro 2010, an interdisciplinary European congress on Neurology, Neurosurgery, Intensive Care, Anesthesiology and Basic Science
Author(s)
Burkhart C.S., Gamberini M., Smielewski P., Monsch A.U., Strebel S.P., Steiner L.A.
Address
Porto, Portugal, February 4-6, 2010
ISBN
0265-0215
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
27
Series
European Journal of Anesthesiology
Pages
S14
Language
english
Abstract
Background: Inadequate intraoperative cerebral perfusion and increased
serum anticholinergic activity (SAA) have been suggested as possible causes
of postoperative cognitive dysfunction (POCD).
Methods: 53 patients aged >65 yrs undergoing elective major surgical procedures
under standardized general anaesthesia. Cerebral perfusion was monitored
with transcranial Doppler and near-infrared spectroscopy. Mx, an index of
cerebral autoregulation was calculated based on the correlation of spontaneous
changes inmean arterial blood pressure (MAP) and cerebral blood flow velocity.
Cognitive function was measured preoperatively and 7 days postoperatively
using the CERAD-Neuropsychological Battery. A postoperative decline >1
z-score in at least 2 cognitive variables was defined as POCD. SAA was
measured preoperatively and 7 days postoperatively (data available for 38
patients). CRP was measured at the same time points and 2 days postoperatively.
Results: Age was 75_7 yrs (mean_SD). 23 patients (43%) developed POCD.
There were no statistical significant differences between patients with POCD
and without POCD in age (77_7 vs 73_6 yrs), MAP (74_12 vs 78_11
mmHg), cerebral tissue oxygenation indices (67_6 vs 69_4 %) SAA
preoperatively (1.74_1.52 vs 1.74_1.21) and 7 days postoperatively
(1.90_1.63 vs 1.84_1.39) and CRP preoperatively (32_72 vs 7_9), 2 days
postoperatively (176_129 vs 111_69) and 7days postoperatively (53_43 vs
48_25). Patients with POCD had less efficient autoregulation than patients
without POCD (Mx 0.55_0.15 vs 0.45_0.20, p = 0.046). However, the percentage
of patients with clearly impaired autoregulation (ie, Mx>0.5) was
statistically not different between groups (with POCD: 65%; without POCD:
38%; p = 0.06) but there seems to be a trend.
Conclusions: Our data on the association between cerebral perfusion and
POCD in elderly patients are inconclusive and more patients need to be
investigated. In this small group of patients SAA seems not to be associated
with POCD.
Create date
20/04/2010 10:41
Last modification date
20/08/2019 13:10
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