Resolution of elevated interleukin-6 after surgery is associated with return of normal cognitive function

British Journal of Anaesthesia, Journal Year: 2023, Volume and Issue: 131(4), P. 694 - 704

Published: June 27, 2023

Language: Английский

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Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: A prospective, randomized, placebo-controlled clinical trial

Medicine, Journal Year: 2024, Volume and Issue: 103(18), P. e37931 - e37931

Published: May 3, 2024

Background: This study evaluates the efficacy of dexmedetomidine (DEX) in reducing postoperative delirium (POD) and modulating pro-inflammatory cytokines elderly patients undergoing thoracolumbar compression fracture surgery. Methods: In this randomized, double-blind, placebo-controlled trial conducted from October 2022 to January 2023 at Anting Hospital Shanghai, 218 were randomized into DEX (n = 110) normal saline (NS, n 108) groups. The group received 0.5 µg/kg/h DEX, incidence was assessed using Confusion Assessment Method (CAM) on days 1 3 post-surgery. Levels interleukins IL-1β, IL-6, tumor necrosis factor-α (TNF-α) measured pre-operation (T0) (T1) (T3). Preoperative day cerebrospinal fluid (CSF) samples treated with varying concentrations olanzapine or observe their regulatory effects expression Phospho-ERK1/2 Phospho-JNK. Results: Dexmedetomidine significantly lowered POD 18.2%, compared 30.6% NS ( P .033). While all showed an initial increase cytokine levels after surgery, by T3, IL-6 TNF-α notably decreased group, no significant change IL-1β across adverse events rate similar between groups, demonstrating safety population. CSF samples, treatment mM downregulated Phospho-JNK upregulated expression, a dose-dependent modulation inflammatory responses. Conclusion: is effective early post-thoracolumbar It also decreases levels, indicating its potential managing Treatment modulated expressions effect inflammation. contributes understanding DEX’s role improving outcomes patients.

Language: Английский

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Insulin resistance and osteocalcin associate with the incidence and severity of postoperative delirium in elderly patients undergoing joint replacement

Geriatrics and gerontology international/Geriatrics & gerontology international, Journal Year: 2024, Volume and Issue: 24(4), P. 421 - 429

Published: March 4, 2024

Aim While insulin sensitivity plays an important role in maintaining glucose metabolic homeostasis and cognitive function, its impact on postoperative delirium (POD) remains unclear. This study aimed to investigate the association between POD indicators of sensitivity, including resistance osteocalcin. Methods A total 120 elderly patients undergoing joint replacement were recruited divided into non‐delirium groups. Plasma cerebrospinal fluid (CSF) samples collected for analysis biomarkers, insulin, uncarboxylated osteocalcin (ucOC), (tOC), glucose. Insulin was assessed through homeostatic model assessment (HOMA‐IR). Main results Out total, 28 (23.3%) experienced within 5 days after surgery. Patients with exhibited higher levels preoperative HOMA‐IR ucOC CSF plasma, tOC ( P = 0.028, < 0.001, 0.005, 0.019). After adjusting variables, age, Mini‐Mental State Examination score, surgical site fracture, only significantly linked incidence (OR 5.940, 0.008; OR 1.208, 0.046, respectively), both which also correlated severity 0.007, 0.001). Receiver operating curve indicated that might partly predict (area under [AUC] 0.697, 95% confidence interval [CI] 0.501–0.775, AUC 0.745, CI 0.659–0.860). Conclusions We observed elevated associated POD. these preliminary need confirmation, they suggest a potential involvement pathological mechanism Geriatr Gerontol Int 2024; 24: 421–429 .

Language: Английский

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Effect of intranasal insulin on perioperative cognitive function in older adults: a randomized, placebo-controlled, double-blind clinical trial

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(9)

Published: Aug. 31, 2024

Abstract Background Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families society. Methods A total 140 who were scheduled for elective orthopaedic surgery or pancreatic with general anaesthesia randomly assigned to Group S I a 1:1 allocation. Patients received intranasal administration 400 μL normal saline 40 IU/400 insulin, respectively, once daily from 5 minutes before induction until 3 days postoperatively. Perioperative function was assessed using Mini-Mental State Examination (MMSE) Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day after postoperative delirium (POD) incidence 3-minute Diagnostic Interview CAM (3D-CAM) 1–3. Serum levels interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β C-reactive protein (CRP) measured first surgery. Results Insulin treatment significantly increased MMSE MoCA-B scores group than (P &lt; 0.001, P = respectively), decreased POD within 3-day period (10.9% vs 26.6%, 0.024), inhibited IL-6 compared 0.034, 0.044, respectively). Conclusions Intranasal insulin is thus suggested as potential therapy improve cognition undergoing However, more standardized multi-centre, large-sample study needed further validate these results.

Language: Английский

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Association between surgical admissions, cognition, and neurodegeneration in older people: a population-based study from the UK Biobank

The Lancet Healthy Longevity, Journal Year: 2024, Volume and Issue: 5(9), P. 100623 - 100623

Published: Sept. 1, 2024

Previous studies have shown that major surgical and medical hospital admissions are associated with cognitive decline in older people (aged 40-69 years at recruitment), which is concerning for patients caregivers. We aimed to validate these findings a large cohort investigate associations neurodegeneration using MRI.

Language: Английский

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Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial

British Journal of Anaesthesia, Journal Year: 2022, Volume and Issue: 130(2), P. e307 - e316

Published: Dec. 13, 2022

Language: Английский

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Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery

Clinical Interventions in Aging, Journal Year: 2023, Volume and Issue: Volume 18, P. 559 - 570

Published: April 1, 2023

Postoperative delirium (POD) is a common complication in operative patients. Neuroinflammation has been reported to be potential mechanism associated with the development of POD. Identifying available inflammatory markers such as C-reactive protein (CRP) would aid clinicians early detection Previous studies have demonstrated that CRP may promising predictive marker for Thus, this study aimed explore association between and POD among those elderly colorectal cancer (CRC) patients.643 patients CRC were included study. levels measured before operation on postoperative day 1. The univariate multivariate regression analyses used identify risk factors POD.Of 643 CRC, 112 cases (17.4%) had showed older age, higher level 1, percentage smoking, diabetes mellitus, chronic obstructive pulmonary disease (COPD) than without Preoperative was not Univariate age (> 70 years), COPD, 1 48 mg/L) patients.Postoperative an independent indicator patients, suggesting role undergoing surgery.

Language: Английский

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Effect of remimazolam vs propofol on emergence from general anesthesia in patients undergoing cerebral endovascular procedures: A randomized controlled, non-inferiority trial

Journal of Clinical Anesthesia, Journal Year: 2023, Volume and Issue: 93, P. 111356 - 111356

Published: Dec. 5, 2023

Language: Английский

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Delirium is associated with loss of feedback cortical connectivity

Alzheimer s & Dementia, Journal Year: 2023, Volume and Issue: 20(1), P. 511 - 524

Published: Sept. 11, 2023

Abstract INTRODUCTION Post‐operative delirium (POD) is associated with increased morbidity and mortality but bereft of treatments, largely due to our limited understanding the underlying pathophysiology. We hypothesized that reflects a disturbance in cortical connectivity leads altered predictions sensory environment. METHODS High‐density electroencephalogram recordings during an oddball auditory roving paradigm were collected from 131 patients. Dynamic causal modeling (DCM) analysis facilitated inference about neuronal inhibition–excitation dynamics auditory‐evoked responses. RESULTS Mismatch negativity amplitudes smaller patients POD. DCM showed was decreased left‐sided superior temporal gyrus (l‐STG) cortex feedback connectivity. Feedback also negatively correlated severity systemic inflammation. Increased inhibition l‐STG, consequent decreases feed‐forward feed‐back connectivity, occurred for tones delirium. DISCUSSION Delirium possibly resulting intrinsic inhibitory tone. Highlights amplitude reduced Patients postoperative had feedforward before surgery. diminished left‐side left primary area inversely inflammation severity.

Language: Английский

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Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients

Frontiers in Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Feb. 14, 2024

Objective This study aims to examine the association between preoperative serum albumin levels and postoperative delirium (POD) in geriatric patients who have undergone hip fracture surgery, with goal of offering novel insights for clinical interventions targeting POD. Methods A retrospective analysis was conducted on medical records underwent surgery a tertiary institution from January 2013 November 2023. The were classified based hypoalbuminemia (defined as level &lt; 35 g/L) threshold. Multivariable logistic regression propensity score matching (PSM) employed calculate adjusted odds ratios (OR) 95% confidence intervals (95% CI) POD eliminate potential confounding factors. Additionally, subgroup performed explore interaction effect. Results cohort included 1,440 patients, an incidence found be 19.1%. In multivariable analysis, had OR 2.99 (95%CI: 2.14–4.18) compared those normal (≥ g/L). Furthermore, significant trend observed across different severity categories, including mild (34.9–30.0 g/L; = 2.71, 95%CI: 1.84–3.99), moderate (29.9–25.0 g/L, 3.44, 1.88–6.28), severe (&lt;25.0 3.97, 1.78–8.86), value p &lt;0.001. Similar results PSM analysis. treating continuous variable, risk increased by 11% CI, 1.08–1.15) each 1 g/L decrease level. Conclusion Low are strongly associated fractures, dose–response relationship exists them.

Language: Английский

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