oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Does depth of anesthesia influence postoperative cognitive dysfunction or inflammatory response following major ENT surgery?
Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology (CAMTÖ), Region Örebro County, Sweden.
2012 (English)In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, Vol. 3, no 6, p. 220-Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major ENT surgery. Thirty two patients aged 40 to 94 yrs, scheduled for surgery under general anesthesia were randomly assigned to one of two groups. In group A (AEP group) depth of anesthesia (DOA) was measured with auditory evoked potential (AEP). In the control group (group C) DOA was monitored according to clinical signs. Cognitive function was evaluated using Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM) and Cognitive Failure Questionnaire (CFQ). Inflammatory markers were measured before and after anesthesia. Perioperative requirements for desflurane and fentanyl were significantly lower in group A. On the first postoperative day MMSE changes indicating POCD were noted in 1 patient in group A and 7 patients in group C (P<0.03). One month follow up did not show any difference between the groups regarding POCD. Our study indicates that AEP-guided anesthesia allows dose reduction of anesthetic agents including opioids leading to better cardiovascular stability and less early POCD. Anesthesia depth did not influence the inflammatory response to surgery.

Place, publisher, year, edition, pages
2012. Vol. 3, no 6, p. 220-
Keywords [en]
Cognitive decline, general anesthesia, auditory evoked potential (AEP)
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-34016DOI: 10.4172/2155-6148.1000220Scopus ID: 2-s2.0-84880002452OAI: oai:DiVA.org:oru-34016DiVA, id: diva2:699972
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2018-05-13Bibliographically approved
In thesis
1. Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
Open this publication in new window or tab >>Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients may suffer from various forms of postoperative cognitive dysfunction (POCD). In most cases, the impact on cognitive function is relatively transient but POCD can sometimes be long-lasting (> 1 year). Studies showing that up to one in four patients with known risk factors are affected by some form of cognitive loss. The cause of cognitive impairment after surgery and anaesthesia is still unclear. One hypothesis is that anaesthetic drugs may have an impact on the inflammatory process which occurs in conjunction to the tissue trauma caused by surgery. Titrating anaesthetic administration by the use of a depth of anaesthesia (DOA) monitors (AEP or BIS), usually reduce anaesthetic consumption and facilitate early recovery. In the initial two studies, the EEG-based DOA monitoring (AEP) was compared with a control group with standard monitoring for administration of anaesthesia. The AEP group required less anaesthetics and opioids and had faster early recovery but was also associated with a lower number of patients with < 25 MMSE score at 24-hours. We found in study III a relationship between the DOA and postoperative inflammatory response (IL-6). Patients with < 25 MMSE score had higher postoperative 24 hrs IL-6 levels. In the final study, we investigated the attitudes and knowledge among Swedish anaesthesiologists and nurse anaesthetists including the use of DOA, and to what extent written procedures regarding the pre-and postoperative cognitivedysfunction were used.

In conclusion, our studies show, the EEG-based guided DOA monitoring reduces consumption of anaesthetics and opioids during surgery, allows a faster postoperative recovery, and reduces the occurrence of cognitive impairment the first day after surgery and decrease inflammatory response after eye surgery. We found also an association between perioperative DOA, cognitive impairment and an increased inflammatory response after surgery. The interest and knowledge about assessment and management of neurocognitive side-effects before and after anaesthesia was found to be low among anaesthesiologists and nurse anaesthetists. They were critical about the benefits of the DOA monitoring. Swedish anaesthesiologists and nurse anaesthetists need to improve their knowledge of assessment and management of cognitive dysfunction.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 101
Keywords
Postoperative cognitive dysfunction, minor and major surgery, anaesthesia, depth of anaesthesia monitoring, auditory evoked potential, AAI, inflammatory marker
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32842 (URN)978-91-7668-987-5 (ISBN)
Public defence
2014-02-07, Hörsal C2, Campus USÖ, Universitetssjukhuset, S Grev Rosengatan, 701 85 Örebro, 08:45 (Swedish)
Opponent
Supervisors
Available from: 2014-01-23 Created: 2013-12-19 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textScopusFulltext

Authority records BETA

Jildenstål, Pether K.Rawal, NarinderBerggren, Lars

Search in DiVA

By author/editor
Jildenstål, Pether K.Rawal, NarinderBerggren, Lars
Anesthesiology and Intensive Care

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 162 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf