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AAI-guided anaesthesia is associated with lower incidence of 24-hour MMSE<25 and may impact the IL-6 response
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden; CAMTÖ, Centre for Assessment of Medical Technology, Örebro, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Trauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia.

Method: This is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-hours.

Results: IL- 6 increased significantly at both 5 and further at 24 hours after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24- hours respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p= 0.008) also between 5 h and 24 h, (p= 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-hour MMSE score less than 25 had a significant higher 24-hour IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002).

Conclusion: The IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE <25 at 24-hours. Further studies are warranted evaluating the role of depth of anaesthesia monitoring on the risk for early cognitive impairment and neuro-inflammation.

Keywords [en]
Cognitive decline, general anaesthesia, auditory evoked potential (AEP) monitoring, minor surgery
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-34018OAI: oai:DiVA.org:oru-34018DiVA, id: diva2:700036
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2017-10-17Bibliographically 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

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Jildenstål, PetherBerggren, Lars

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Citation style
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