Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(7)

Published: July 1, 2024

Abstract Background Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length hospital stay (LOS), dementia and mortality Methods PubMed Scopus were searched until May 2023. All studies major surgical patients that assessed outcomes interest included. effects stratified by surgery type (cardiac noncardiac) time assessment (<30 ≥30 days postsurgery). Results Of 2316 studies, 20 met inclusion criteria. was not associated with functional postsurgery. Patients who experienced postcardiac had an increased relative risk (RR) death 2.04 [(95% CI: 1.18, 3.50); I2 = 0.00%]. Sensitivity analyses showed associations intermediate-term among noncardiac patients, RR 1.84 1.26, 2.71); developed <30 surgeries longer LOS than those did [mean difference (MD) 1.37 (95% 0.35, 2.39); 92.38% MD 1.94 0.48, 3.40); 83.29%, respectively]. delirium (POD) may contribute heterogeneity observed, but limited data reported within Conclusions undergoing cardiac postsurgery poorer premature death. Early recognition perioperative neurocognitive disorders at-risk enable early intervention. However, POD confound our findings, further necessary disentangle from clinical

Language: Английский

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Sevoflurane versus propofol on immediate postoperative cognitive dysfunction in patients undergoing cardiac surgery under cardiopulmonary bypass: a comparative analysis

Journal of Cardiothoracic Surgery, Journal Year: 2025, Volume and Issue: 20(1)

Published: Jan. 10, 2025

This study aims to compare the effects of sevoflurane (SEV) and propofol (PRO) on postoperative cognitive dysfunction (POCD) in patients undergoing cardiac surgery (CS) under cardiopulmonary bypass (CPB), with a focus evaluating efficacy these anesthetic agents preventing POCD. A total 113 CS CPB were grouped into two: PRO group (n = 58) SEV 55). Baseline data, anesthesia (CPB duration, time, respiratory recovery time), Montreal Cognitive Assessment (MoCA) scores, POCD incidence, neurological function markers (NSE, S-100β, MMP9), serum inflammatory (IL-6, IL-8, TNF-α) analyzed. The was conducted between March 2018 May 2021. showed significantly shorter time (P < 0.05), 0.05) compared group. MoCA score reduced markedly baseline, but still higher than that 0.05). incidence lower (5.17% vs. 27.27%, P 0.001). levels NSE, MMP9, IL-6, TNF-α elevated baseline values, those 0.05 for all comparisons). is more effective CPB. It provides superior offers better protection against neuronal damage inflammation SEV. Not applicable.

Language: Английский

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Postoperative Delirium and Cognitive Dysfunction After Cardiac Surgery: The Role of Inflammation and Clinical Risk Factors

Diagnostics, Journal Year: 2025, Volume and Issue: 15(7), P. 844 - 844

Published: March 26, 2025

Background/Objectives: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are prevalent neurological complications following cardiac surgery, significantly affecting patient recovery long-term outcomes, including increased risk of persistent impairment, functional decline, mortality. Understanding the underlying mechanisms factors for POD/POCD is crucial improving perioperative management. This study aimed to investigate relationship between systemic inflammation, assessed through inflammatory markers, occurrence POD POCD in patients undergoing surgery. Methods: We prospectively enrolled 88 aged 18-79 years open-heart Patients with preoperative impairment or high surgical (based on EuroSCORE SOFA scores) were excluded focus impact inflammation a relatively unselected cohort. responses (CRP, NLR, IL-6, IL-17A, SII, SIRI) measured, (CAM-ICU) (neuropsychological testing) during hospitalization at 3 months follow-up. Statistical comparisons performed who developed those did not. Results: was confirmed across cohort, significant increases CRP, SIRI. While correlational analyses changes individual markers not statistically entire exhibited higher levels IL-6 NLR 48 h postoperatively (p < 0.05). Established clinical associated included older age, prolonged cardiopulmonary bypass (CPB) duration, extended mechanical ventilation, vasopressor support blood transfusion, renal dysfunction, elevated creatine kinase (CK) lactate dehydrogenase (LDH) Ejection fraction (EF) 45% atrial fibrillation (AF) also more group. Conclusions: Our findings emphasize role response, particularly conjunction established factors, development after levels, readily measurable cost-effective may contribute identifying risk. Comprehensive management strategies targeting modifiable organ function mitigating outcomes this vulnerable population.

Language: Английский

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Effects of Midazolam and Dexmedetomidine on Cognitive Dysfunction Following Open‐Heart Surgery: A Comprehensive Review

Brain and Behavior, Journal Year: 2025, Volume and Issue: 15(4)

Published: April 1, 2025

ABSTRACT Purpose Patients undergoing open‐heart surgery often face significant challenges in postoperative cognitive dysfunction (POCD). There has been growing interest understanding how anesthesia medications, such as dexmedetomidine (DEX) and midazolam, impact function these patients. Method This comprehensive review aims to detail the effect of DEX midazolam on outcomes following surgery. Findings Midazolam, a highly selective commonly used benzodiazepine for preoperative anxiolytics sedation associated with POCD. However, evidence regarding its is vague; some studies suggest potential link between administration impairment, while others report no or even an improvement abilities. neuroprotective agent cardiac The effects function, including reduction POCD incidence severity, have reported several studies. It modulates inflammatory responses, attenuates oxidative stress, preserves cerebral perfusion. Although show promising results, their are yet be elucidated. Conclusion Various factors, patient characteristics, perioperative management, surgical procedures, may influence outcomes, highlighting need further research better understand roles agents

Language: Английский

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The known and unknown of post-pump chorea: a case report on robust steroid responsiveness implicating occult neuroinflammation

Frontiers in Immunology, Journal Year: 2024, Volume and Issue: 15

Published: Sept. 10, 2024

Post-pump chorea (PPC) is characterized by the development of choreiform movements following cardiopulmonary bypass (CPB) surgery. PPC occurs almost exclusively in children, and its pathophysiology remains unclear. Here we present an adult case after bovine aortic valve replacement (AVR) which exhibited dramatic reproducible response to steroid, suggesting presence occult neuroinflammation. This observation suggests a novel underlying mechanism certain subgroups PPC, likely heterogeneous condition start with. Further research into pathomechanisms could offer insights managing this otherwise symptomatic control-only condition.

Language: Английский

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Association of inflammation, oxidative stress, and deteriorated cognitive functions in patients after cardiac surgery

Vessel Plus, Journal Year: 2024, Volume and Issue: unknown

Published: July 11, 2024

The study is focused on the connection between cognitive dysfunction, inflammatory processes, oxidative stress, and various associated biological factors. Postoperative dysfunction a condition where patient exhibits temporary deterioration in function after surgery, which may include problems with memory, concentration, overall performance. While most common among elderly patients, it can occur individuals of any age. causes are not fully elucidated, but assumed that peripheral trauma during long-term surgical interventions behind development inflammation creation conditions leads to disruption blood-brain barrier subsequent impairment. This review aims describe detected changes at level selected markers damage primarily cardiac surgery.

Language: Английский

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