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Zheng ZP, Zhang YG, Long MB, Ji KQ, Peng JY, He K. Construction of a risk prediction model for postoperative cognitive dysfunction in colorectal cancer patients. World J Gastrointest Surg 2025; 17:104459. [DOI: 10.4240/wjgs.v17.i4.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/06/2025] [Accepted: 02/24/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most prevalent and lethal malignant tumors worldwide. Currently, surgical intervention was the primary treatment modality for CRC. However, increasing studies have revealed that CRC patients may experience postoperative cognitive dysfunction (POCD).
AIM To establish a risk prediction model for POCD in CRC patients and investigate the preventive value of dexmedetomidine (DEX).
METHODS A retrospective analysis was conducted on clinical data from 140 CRC patients who underwent surgery at the People’s Hospital of Qian Nan from February 2020 to May 2024. Patients were allocated into a modeling group (n = 98) and a validation group (n = 42) in a 7:3 ratio. General clinical data were collected. Additionally, in the modeling group, patients who received DEX preoperatively were incorporated into the observation group (n = 54), while those who did not were placed in the control group (n = 44). The incidence of POCD was recorded for both cohorts. Data analysis was performed using statistical product and service solutions 20.0, with t-tests or χ2 tests employed for group comparisons based on the data type. Least absolute shrinkage and selection operator regression was applied to identify influencing factors and reduce the impact of multicollinear predictors among variables. Multivariate analysis was carried out using Logistic regression. Based on the identified risk factors, a risk prediction model for POCD in CRC patients was developed, and the predictive value of these risk factors was evaluated.
RESULTS Significant differences were observed between the cognitive dysfunction group and the non-cognitive dysfunction group in diabetes status, alcohol consumption, years of education, anesthesia duration, intraoperative blood loss, intraoperative hypoxemia, use of DEX during surgery, intraoperative use of vasoactive drugs, surgical time, systemic inflammatory response syndrome (SIRS) score (P < 0.05). Multivariate Logistic regression analysis identified that diabetes [odds ratio (OR) = 4.679, 95% confidence interval (CI) = 1.382-15.833], alcohol consumption (OR = 5.058, 95%CI: 1.255-20.380), intraoperative hypoxemia (OR = 4.697, 95%CI: 1.380-15.991), no use of DEX during surgery (OR = 3.931, 95%CI: 1.383-11.175), surgery duration ≥ 90 minutes (OR = 4.894, 95%CI: 1.377-17.394), and a SIRS score ≥ 3 (OR = 4.133, 95%CI: 1.323-12.907) were independent risk factors for POCD in CRC patients (P < 0.05). A risk prediction model for POCD was constructed using diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score as factors. A receiver operator characteristic curve analysis of these factors revealed the model’s predictive sensitivity (88.56%), specificity (70.64%), and area under the curve (AUC) (AUC = 0.852, 95%CI: 0.773-0.919). The model was validated using 42 CRC patients who met the inclusion criteria, demonstrating sensitivity (80.77%), specificity (81.25%), and accuracy (80.95%), and AUC (0.805) in diagnosing cognitive impairment, with a 95%CI: 0.635-0.896.
CONCLUSION Logistic regression analysis identified that diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score vigorously influenced the occurrence of POCD. The risk prediction model based on these factors demonstrated good predictive performance for POCD in CRC individuals. This study offers valuable insights for clinical practice and contributes to the prevention and management of POCD under CRC circumstances.
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Affiliation(s)
- Zhen-Ping Zheng
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
| | - Yong-Guo Zhang
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
| | - Ming-Bo Long
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
| | - Kui-Quan Ji
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
| | - Jin-Yan Peng
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
| | - Kai He
- Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
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Grüßer L, Coburn M, Schmid M, Rossaint R, Ziemann S, Kowark A. Characteristics and outcomes of older patients undergoing out- versus inpatient surgery in Europe. A secondary analysis of the Peri-interventional Outcome Study in the Elderly (POSE). Acta Anaesthesiol Scand 2025; 69:e70021. [PMID: 40126142 PMCID: PMC11932067 DOI: 10.1111/aas.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 03/02/2025] [Accepted: 03/04/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND The number of older patients undergoing surgical procedures with anaesthesia care is projected to rise. In order to cope with the increased demand, the expansion of outpatient surgery may play a decisive role. We aim to investigate the characteristics and outcomes of the older outpatient population. PATIENTS AND METHODS The Peri-interventional Outcome Study in the Elderly in Europe (POSE) was a prospective multicenter study investigating characteristics and outcomes in 9497 patients aged 80 years and older undergoing a procedure with anaesthesia care. This secondary analysis of the POSE data investigated characteristics, functional and cognitive outcomes, and mortality in the outpatient in comparison to the inpatient population. Functional status was assessed as independent, partially dependent, and totally dependent at baseline and 30 days postinterventional. Cognitive status was defined by the number of recalled words (0-3) in the Mini-Cog test and brief cognitive screening at baseline and follow-up. RESULTS Out of the 9497 older patients, 7562 were planned inpatients and 1935 planned outpatients. Older outpatients presented with fewer comorbidities and fewer medications than older inpatients and underwent minor procedures more often Their baseline functional status was more often independent, and they had a higher estimated probability of staying independent. Outpatients recalled three words at baseline and follow-up more often than inpatients. The estimated 30-day survival probabilities with 95% confidence intervals were 0.997 [0.994; 0.999] in the group with planned outpatient surgery and 0.948 [0.942; 0.953] with planned inpatient surgery. CONCLUSION Our results indicate that functional and cognitive status at baseline and follow-up were higher in planned outpatients than in planned inpatients. However, only short screening tools for the assessment of functional and cognitive status were used. Overall, outpatient interventions were associated with low mortality. Further research is recommended to develop scores that facilitate the identification of patients suitable for outpatient surgery. EDITORIAL COMMENT This secondary analysis of a prospectively collected cohort of elderly surgical cases in Europe describes case factors related to inpatient compared to outpatient surgical interventions. The findings show that inpatient or outpatient surgery selection is associated with different degrees of risk for important perioperative outcomes in this cohort.
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Affiliation(s)
- Linda Grüßer
- Department of AnaesthesiologyUniversity Hospital RWTH AachenAachenNorth Rhine‐WestphaliaGermany
| | - Mark Coburn
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnNorth Rhine‐WestphaliaGermany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of MedicineUniversity of BonnBonnNorth Rhine‐WestphaliaGermany
| | - Rolf Rossaint
- Department of AnaesthesiologyUniversity Hospital RWTH AachenAachenNorth Rhine‐WestphaliaGermany
| | - Sebastian Ziemann
- Department of AnaesthesiologyUniversity Hospital RWTH AachenAachenNorth Rhine‐WestphaliaGermany
| | - Ana Kowark
- Department of AnaesthesiologyUniversity Hospital RWTH AachenAachenNorth Rhine‐WestphaliaGermany
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnNorth Rhine‐WestphaliaGermany
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Jing X, Zhao Y, Wang G, Tian W. Ginsenoside 1 mitigates postoperative cognitive dysfunction by enhancing microglial Aβ clearance through the endo-lysosomal pathway. Int Immunopharmacol 2025; 150:114281. [PMID: 39946773 DOI: 10.1016/j.intimp.2025.114281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 02/08/2025] [Accepted: 02/08/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common complication in patients after surgery, especially in the elderly. The incidence of POCD not only impaired learning and memory, but also increased morbidity and mortality in patients. However, the exploration of therapeutic agents is limited. Ginsenoside 1 (Rg1) is one of the main compounds of ginseng, which exhibits bioactive and neuroprotective efficiency. In the present study, we aimed to investigate the effects of Rg1 on POCD. METHODS The POCD model was established by performing aseptic laparotomy surgery under anesthesia in 18-month mice. The cognition and anxiety of mice were assessed with MWM, OFT, and NOR tests. An in vitro model was performed on BV2 microglial cells. RNA sequencing, Western blotting, electrophysiology, Golgi staining, engulfment, and immunofluorescence analysis were performed. RESULTS Our results showed that Rg1 effectively alleviated the cognitive dysfuncion and anxiety of POCD mice. Transcriptomic sequencing data in microglia indicated that Rg1 mainly affects endosomes and lysosomes. By upregulating Rab7 and TFEB expression, Rg1 promoted microglial engulfment of Aβ through the endo-lysosomal pathway. Additionally, Rg1 reduced inflammatory levels, increased synaptic plasticity, and mitigated neuronal damage caused by Aβ. Moreover, the effects of Rg1 on TFEB depended on MEK/ERK signaling, while activation of MEK reversed Rg1's protective effects. CONCLUSIONS In conclusion, our study demonstrates that Rg1 can effectively ameliorate cognitive and synaptic deficit by enhancing microglial Aβ clearance through the endo-lysosomal pathway in aged POCD mice, which provides a potential strategy for the prevention of POCD.
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Affiliation(s)
- Xu Jing
- Department of Anesthesiology Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University, Huai'an Second People's Hospital, Jiangsu Province 223001, China
| | - Yongchang Zhao
- Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University, Huai'an Second People's Hospital, Jiangsu Province 223001, China
| | - Gang Wang
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Weiqian Tian
- Department of Anesthesiology Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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Hung KC, Kao CL, Ho CN, Wu JY, Chang YJ, Lin CM, Chen IW. Efficacy and safety of esketamine in preventing perioperative neurocognitive disorders: a meta-analysis of randomized controlled studies. Syst Rev 2025; 14:68. [PMID: 40121475 PMCID: PMC11929294 DOI: 10.1186/s13643-025-02807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 03/04/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Perioperative neurocognitive disorders (POND) are common in older adults and are associated with adverse outcomes. This meta-analysis aimed to evaluate the efficacy and safety of esketamine for the prophylaxis of POND. METHODS Electronic databases were comprehensively searched from inception to April 1, 2024, to identify randomized controlled trials (RCTs) exploring the impact of perioperative esketamine on POND in adult patients. The primary outcomes were the incidence of POND and the level of postoperative cognitive function. The secondary outcomes included recovery characteristics (i.e., respiratory depression, extubation time, agitation, hallucinations, and nightmares) and inflammatory markers. Subgroup and meta-regression analyses were conducted to investigate the heterogeneity and effect of esketamine dosage. RESULTS A total of 24 RCTs (n = 2,130 patients), all conducted in China with relatively short follow-up periods (≤ 3 months), were included. Esketamine was found to significantly reduce the risk of POND (risk ratio:0.53, 95%confidence interval [CI]: 0.43-0.67) and improved cognitive function on postoperative day 1 (standardized mean difference [SMD]:1.22, 95%CI:0.85-1.59) and day 3 (SMD:0.94, 95%CI: 0.46-1.43) compared with controls, without impacting recovery characteristics. Furthermore, esketamine was associated with lower pain scores, reduced risk of postoperative nausea/vomiting, and decreased levels of inflammatory markers (IL-6, TNF-α, and S100β). Subgroup and meta-regression analyses revealed that age, quality of studies, type of esketamine administration, and esketamine dosage did not have a significant impact on cognitive outcomes. The evidence showed moderate certainty for POND risk, low certainty for POD 1 cognitive function and several complications (agitation, hallucinations, PONV, respiratory issues, nightmares) and biomarkers (TNF-α, s100β), and very low certainty for POD 3 cognition, extubation time, pain, and IL-6 levels. CONCLUSION Perioperative esketamine is potentially effective in reducing the risk of POND and improving cognitive function in adult patients, regardless of age and dosage. Nevertheless, the certainty of evidence was low to very low for several outcomes (e.g., cognitive function on POD 3). Given that all included studies were conducted in China with relatively short follow-up periods, further high-quality RCTs with diverse populations and longer follow-up are warranted to validate these findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan.
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
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Chen X, Wan H, Huang Y, Chen A, Wu X, Guo Y, Wei J, Chen P, Jiang J, Zheng X. Repeated lidocaine exposure induces synaptic and cognitive impairment in aged mice by activating microglia and neurotoxic A1 astrocytes. iScience 2025; 28:112041. [PMID: 40092614 PMCID: PMC11910116 DOI: 10.1016/j.isci.2025.112041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 06/28/2024] [Accepted: 02/13/2025] [Indexed: 03/19/2025] Open
Abstract
In the perioperative setting, the administration of intravenous lidocaine is widespread. This study investigates the effects of varying frequencies of intravenous lidocaine on cognitive function in mice of differing ages. Young adult and aged mice received systemic lidocaine either once or three times. Our findings indicated that repeated exposure to systemic lidocaine in aged mice resulted in cognitive impairment, accompanied by neuronal apoptosis and synaptic loss in the hippocampus. Additionally, repeated lidocaine exposure activated microglia and neurotoxic A1 astrocytes in aged mice. Notably, the adverse effects were significantly diminished when aged mice were treated with dehydroxymethylepoxyquinomicin (DHMEQ), a specific NF-κB inhibitor. Furthermore, depleting microglia with PLX5622 effectively prevented the activation of A1 astrocytes and synaptic loss following lidocaine exposure. This study provides evidence linking age and exposure frequency to cognitive impairment due to systemic lidocaine administration, correlating with the activation of microglia and neurotoxic A1 astrocytes.
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Affiliation(s)
- Xiaohui Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Haiyang Wan
- Department of Anesthesiology, First Affiliated Hospital of Yangtze University, First People's Hospital of Jingzhou, Jingzhou, China
| | - Yongxin Huang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Xuyang Wu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Yanhua Guo
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Jianjie Wei
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Pinzhong Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Jiangdan Jiang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fuzhou, China
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Cai Y, Yu F, Wu W, Chen W. Study on the mechanism of Dexmedetomidine's effect on postoperative cognitive dysfunction in elderly people. Front Physiol 2025; 16:1508661. [PMID: 40144543 PMCID: PMC11936804 DOI: 10.3389/fphys.2025.1508661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 02/19/2025] [Indexed: 03/28/2025] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication among elderly patients following surgical procedures, significantly impairing postoperative recovery and quality of life. The selection and dosage of intraoperative anaesthetic drugs are frequently implicated as contributing factors in the development of POCD. In recent years, dexmedetomidine (DEX), a novel α2-adrenoceptor agonist, has been increasingly utilized in surgical anaesthesia for elderly patients, showing potential as both a preventive and therapeutic agent for POCD. This paper provides a comprehensive review of current research on the mechanisms by which DEX affects POCD in the elderly. Additionally, it explores DEX's mechanisms of action in the context of neuroprotection, anti-inflammation, antioxidative stress, and the regulation of apoptosis, autophagy, and analgesia. The objective is to provide reliable theoretical support and a reference point for the clinical application of DEX in POCD among the elderly, thereby promoting its broader use in clinical practice to improve outcomes and enhance quality of life.
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Affiliation(s)
- Yuanbin Cai
- Department of Anesthesiology, Putuo District Central Hospital, Shanghai, China
| | - Fan Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Wei Wu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Wurong Chen
- Department of Anesthesiology, Putuo District Central Hospital, Shanghai, China
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Nakazawa K, Ishikawa R, Suzuki T. Ultrasound-Guided Rectus Sheath Block With Monitored Anesthesia Care for Necrotic Umbilical Hernia Repair in a Patient With Severe Liver Failure and Refractory Ascites: A Case Report. Cureus 2025; 17:e80433. [PMID: 40083587 PMCID: PMC11906206 DOI: 10.7759/cureus.80433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2025] [Indexed: 03/16/2025] Open
Abstract
Patients with severe liver dysfunction present significant perioperative challenges, including the risk of postoperative cognitive dysfunction (POCD) and hepatic encephalopathy (HE), after general anesthesia. While avoiding general anesthesia and deep sedation is crucial for early recovery in this patient population, neuraxial block techniques are often contraindicated due to coagulation disorders. A 73-year-old male patient (190 cm tall, weighing 77 kg) with Child-Pugh C cirrhosis (score 10), coagulopathy (platelets 90,000/μL, prothrombin time (PT) activity 47%), and complex medical history, including treated hepatocellular carcinoma, renal cancer, and bladder cancer, underwent necrotic umbilical hernia repair. The patient, classified as American Society of Anesthesiologists (ASA) physical status IV with a Model for End-Stage Liver Disease (MELD) score of 19, had been hospitalized for two months due to an umbilical hernia infection refractory to antibiotic therapy. After careful preoperative assessment, we selected monitored anesthesia care (MAC) as the preferred anesthetic approach due to the patient's high surgical risk. We performed a bilateral rectus sheath block (RSB) using diluted ropivacaine (0.15%, total 80 mL) with epinephrine (15 μg). Sedation was achieved using dexmedetomidine without a loading dose, supplemented with midazolam and low-dose remifentanil. This approach allowed us to maintain spontaneous breathing while providing adequate analgesia and patient comfort. The surgery was completed successfully with stable hemodynamics and respiratory functions. Throughout the procedure, hemodynamic parameters remained within 20% of baseline values, and bispectral index (BIS) values were maintained between 65 and 80, indicating appropriate sedation depth without excessive anesthetic administration. Ultrasound-guided RSB combined with carefully titrated MAC provides safe and effective anesthesia for umbilical hernia repair in patients with severe liver dysfunction. This approach maintains spontaneous breathing, delivers effective analgesia for somatic and visceral pain, and facilitates clearer differentiation between residual anesthetic effects and worsening HE postoperatively. When coagulopathy precludes neuraxial techniques, this pharmacokinetically informed strategy offers a valuable alternative for high-risk abdominal wall procedures.
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Affiliation(s)
| | - Risyun Ishikawa
- Anesthesiology, Nihon University School of Medicine, Tokyo, JPN
| | - Takahiro Suzuki
- Anesthesiology, Nihon University School of Medicine, Tokyo, JPN
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Suo Z, Xiao T, Qu Y, Zheng Y, Xu W, Zhou B, Yang J, Yu J, Zheng H, Ni C. Aged hippocampal single-cell atlas screening unveils disrupted neuroglial system in postoperative cognitive impairment. Aging Cell 2025; 24:e14406. [PMID: 39540334 PMCID: PMC11896209 DOI: 10.1111/acel.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 10/08/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
Glia-neuron interaction is a crucial feature in aged hippocampus during the occurrence of postoperative cognitive impairment. However, the regulatory effects of microglia, astrocytes, and oligodendrocytes in this glia-neuron interaction, the potential mechanisms and gene targets are still to be elucidated. Here, single-cell RNA sequencing was performed to detect the perioperative genomic expression characteristics of neuroglial system in the hippocampus of aged mice, and to investigate the potential cross-cellular mechanisms and valuable treatment options for glia-neuron interaction-related cognitive impairment. We found that postoperative neurons and glia cells exhibited protein dysmetabolism and mitochondrial electron misrouting. Impaired autophagy and circadian rhythm worsened microglia activation/neuroinflammation, and exacerbated these metabolic alterations. Reactive microglia also aggravated astrocyte and oligodendrocyte cytotoxicity through the PGD2/DP and complement pathways, altering glutamate level and synaptic function via the "tripartite synapses" model, and affecting neuronal myelination. Ligand-receptor communication also indicated these synaptic and axonal dysfunctions via enhanced MDK and PTN pathways. Additionally, we found that anesthetic dexmedetomidine hold therapeutic potential within the disrupted neuroglial system. It enhanced neuronal metabolic rebalance (Atf3-related) and reduced neuroinflammation from a multicellular perspective, therefore improving postoperative cognitive impairment. Together, our study proposes an aged hippocampal cell atlas and provides insights into the role of disrupted glia-neuron cycle in postoperative cognitive impairment. Our findings also elucidate the therapeutic potential and mechanism of dexmedetomidine intervention.
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Affiliation(s)
- Zizheng Suo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ting Xiao
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yinyin Qu
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenjie Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Bowen Zhou
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jing Yang
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Jie Yu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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9
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Xue R, Li Y, Zhan M, Yang L, Sun D. Improved early postoperative cognition in elderly gastrointestinal patients: a randomized controlled trial on the role of ultrasound-guided stellate ganglion block. Front Aging Neurosci 2025; 17:1503314. [PMID: 40007697 PMCID: PMC11850532 DOI: 10.3389/fnagi.2025.1503314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 01/30/2025] [Indexed: 02/27/2025] Open
Abstract
Background This study evaluates the impact of ultrasound-guided stellate ganglion block (SGB) on early postoperative cognitive dysfunction (POCD) in elderly patients who underwent laparoscopic gastrointestinal (GI) surgery, as well as its potential effect on oxidative stress and inflammatory responses. Methods In this randomized controlled trial, 104 elderly patients scheduled for elective laparoscopic GI surgery were randomized to receive ultrasound-guided SGB before general anesthesia (SGB group) or general anesthesia alone (control group). A total of 98 patients completed the study. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) preoperatively, and on postoperative days one and three. The perioperative recordings included mean arterial pressure, heart rate, and the bispectral index. Blood samples were analyzed for interleukin-6 (IL-6), superoxide dismutase (SOD), and malondialdehyde (MDA). Results The SGB group had a significantly lower incidence of POCD on postoperative day one (p < 0.05). IL-6 and MDA levels were significantly lower, while SOD levels were higher in the SGB group, when compared to the control group (p < 0.05). MDA levels were notably lower on postoperative day three in the SGB group (p < 0.05). Both groups showed significant changes in IL-6, SOD and MDA levels, when compared to preoperative values. The hemodynamic indicators showed a slight reduction in intraoperative blood pressure and decreased numerical rating scale scores on the first postoperative day without significant differences in other indicators. Conclusion Preoperative SGB reduces early POCD in elderly patients who undergo laparoscopic GI surgery, possibly through the inhibition of oxidative stress and inflammatory responses.
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Affiliation(s)
| | | | | | - Lin Yang
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Defeng Sun
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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10
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Wang L, Wang ZH, Zhu DQ, Xie XY, Chen X, Wang XL. Application value of central venous-arterial carbon dioxide partial pressure difference in postoperative cognitive dysfunction in patients with acute aortic dissection. J Cardiothorac Surg 2025; 20:32. [PMID: 39757233 DOI: 10.1186/s13019-024-03300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 12/25/2024] [Indexed: 01/07/2025] Open
Abstract
OBJECTIVE This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection. METHODS A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 min after rewarming, and 5 min before weaning from CPB. The partial PV-aCO2 was calculated. Based on the average PV-aCO2 value, patients were divided into an observation group (PV-aCO2 > 6 mmHg, n = 112) and a control group (PV-aCO2 < 6 mmHg, n = 124). The perioperative data and Mini-Mental State Examination (MMSE) scores were compared between the two groups to assess the incidence and severity of POCD. Additionally, the expression levels of peripheral serum S100β in the two groups were compared 6 h postoperatively. RESULTS The incidence of POCD was higher in the observation group compared to the control group, while MMSE scores and serum S100β levels were lower in the observation group. Additionally, the observation group patients with POCD had lower MMSE scores and serum S100β levels compared to the control group patients. In addition, logistic regression analysis revealed that advanced age, serum S100β levels, female gender, CPB time, unilateral brain perfusion time, hyperlipidemia, diabetes, and smoking history were all independent risk factors for postoperative POCD (all P < 0.05). CONCLUSION Pv-aCO2 can effectively reflect the intraoperative cerebral metabolic level in patients with acute aortic dissection and can serve as an intraoperative warning indicator for cognitive dysfunction. Its clinical recommendation for use is warranted.
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Affiliation(s)
- Lei Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Hong Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Duan Qi Zhu
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Yi Xie
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Xiao Liang Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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11
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Chen Z, Zuo Z, Zhang Y, Shan G, Zhang L, Gong M, Ye Y, Ma Y, Jin Y. Bibliometric Analysis of Neuroinflammation and Postoperative Cognitive Dysfunction. Brain Behav 2025; 15:e70271. [PMID: 39789906 PMCID: PMC11726684 DOI: 10.1002/brb3.70271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 12/18/2024] [Accepted: 12/19/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND The occurrence and development of postoperative cognitive dysfunction (POCD) are closely linked to neuroinflammation. This bibliometric analysis aims to provide novel insights into the research trajectory, key research topics, and potential future development trends in the field of neuroinflammation-induced POCD. METHODS The Web of Science Core Collection (WoSCC) database was searched to identify publications from 2012 to 2023 on neuroinflammation-induced POCD. Bibliometric analysis, involving both statistical and visual analyses, was conducted using CiteSpace, VOSviewer, and the R software. RESULTS Research on neuroinflammation-induced POCD has exhibited an increasing trend over the past 12 years. China had the highest number of publications, Nanjing Medical University had the most collaboration with other institutions, Zhiyi Zuo was the most published author, and the Journal of Neuroinflammation served as the primary publication in the field of neuroinflammation-induced POCD. The most frequent keyword was POCD. Keyword clustering analysis indicated that the predominant cluster is dexmedetomidine. Burst detection revealed that postoperative delirium (POD), perioperative neurocognitive disorders (PND), apoptosis, and epigenetic modifications were the future research trends. CONCLUSIONS Our analysis identified the following key research areas associated with neuroinflammation-induced POCD: anesthesia, surgery, dexmedetomidine, NLRP3 inflammasome, and mechanism of neuroinflammation-induced POCD. The potential future research topics comprise POD, PND, apoptosis, and epigenetic modifications.
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Affiliation(s)
- Zheping Chen
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain‐Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of MedicineTongji UniversityShanghaiPeople's Republic of China
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Zhenxiang Zuo
- Department of Gastroenterology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Yizheng Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Guoliang Shan
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Le Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Moxuan Gong
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Yuyang Ye
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Yufeng Ma
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Yanwu Jin
- Department of Anesthesiology, the Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
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12
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Zhao H, Fan M, Zhang J, Gao Y, Chen L, Huang L. Amyloid beta-induced mitochondrial dysfunction and endothelial permeability in cerebral microvascular endothelial cells: The protective role of dexmedetomidine. Brain Res Bull 2025; 220:111137. [PMID: 39577505 DOI: 10.1016/j.brainresbull.2024.111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 11/11/2024] [Accepted: 11/19/2024] [Indexed: 11/24/2024]
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication in patients who undergo anesthesia in different types of surgeries. Emerging evidence implicates elevated beta-amyloid (Aβ) in the pathogenesis of POCD. Meanwhile, Dexmedetomidine (DEX) has recently shown promise in reducing POCD incidence. This study aimed to elucidate the role of Aβ in inducing endothelial permeability in cerebral microvascular endothelial cells and the underlying mechanisms and testing the effects of DEX. We demonstrated that Aβ1-42, the prevalent Aβ form related to POCD, is cytotoxic to HBMECs, increasing transendothelial permeability and inducing mitochondrial dysfunction, as evidenced by elevated mitochondrial reactive oxygen species (ROS) and decreased ATP production and mitochondrial membrane potential. Furthermore, Aβ1-42 was shown to inhibit Sirt3, exacerbating mitochondrial dysfunction. Conversely, DEX was found to prevent Aβ1-42-induced mitochondrial dysfunction and permeability increases and preserved tight junction proteins in HBMECs.These findings suggest that DEX, as a Sirt3 activator, may offer a pharmacological strategy to mitigate Aβ1-42-related cerebral microvascular endothelial cell dysfunction and preserve cognitive function post-surgery.
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Affiliation(s)
- Haifeng Zhao
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050061, PR China; Department of Anesthesiology, Shijiazhuang Obstetrics and Gynecology Hospital, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Mingyue Fan
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Jin Zhang
- Department of Anesthesiology, Shijiazhuang Obstetrics and Gynecology Hospital, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Yi Gao
- Department of Anesthesiology, Shijiazhuang Obstetrics and Gynecology Hospital, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Liang Chen
- Department of Anesthesiology, Shijiazhuang Obstetrics and Gynecology Hospital, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050061, PR China; Hebei Key Laboratory of Neurodegenerative Disease Mechanism, PR China; Key Laboratory of Clinical Neurology (Hebei Medical University), Ministry of Education, PR China.
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13
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Sun J, Du X, Chen Y. Current Progress on Postoperative Cognitive Dysfunction: An Update. J Integr Neurosci 2024; 23:224. [PMID: 39735960 DOI: 10.31083/j.jin2312224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/14/2024] [Accepted: 08/14/2024] [Indexed: 12/31/2024] Open
Abstract
Postoperative cognitive dysfunction (POCD) represents a significant clinical concern, particularly among elderly surgical patients. It is characterized by a decline in cognitive performance, affecting memory, attention, coordination, orientation, verbal fluency, and executive function. This decline in cognitive abilities leads to longer hospital stays and increased mortality. This review provides a comprehensive overview of the current progress in understanding the relevant pathogenic factors, possible pathogenic mechanisms, diagnosing, prevention and treatment of POCD, as well as suggesting future research directions. It discusses neuronal damage, susceptible genes, central cholinergic system, central nervous system (CNS) inflammation, stress response and glucocorticoids, and oxidative stress in the development of POCD, aiming to uncover the pathological mechanism and develop effective treatment strategies for POCD.
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Affiliation(s)
- Jing Sun
- Department of Anesthesia and Perioperative Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Xiaohong Du
- Department of Anesthesia and Perioperative Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Yong Chen
- Department of Anesthesia and Perioperative Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
- Jiangxi Province Key of Laboratory of Anesthesiology, 330006 Nanchang, Jiangxi, China
- Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), San Francisco, CA 94158, USA
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14
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Zhou Y, Wang Y, Xu L. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia. Open Med (Wars) 2024; 19:20241085. [PMID: 39711844 PMCID: PMC11662949 DOI: 10.1515/med-2024-1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/20/2024] [Accepted: 10/14/2024] [Indexed: 12/24/2024] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) frequently occurs following endovascular therapy for acute ischemic stroke (AIS). Given the complexity of predicting AIS clinically, there is a pressing need to develop a preemptive prediction model and investigate the impact of anesthesia depth on AIS. Methods A total of 333 patients diagnosed with AIS were included in the study, comprising individuals with non-POCD (n = 232) or POCD (n = 101). Univariate and multivariate logistic regression analyses were utilized to examine the independent risk factors associated with POCD. A calibration, decision curve analysis, and precision-recall curves were employed to assess the model's goodness of fit. Results Multivariate regression analysis identified two inflammatory indicators, high-sensitivity C reactive protein (hs-CRP) and systemic immune inflammatory index (SII), and three brain injury indicators, National Institute of Health Stroke Scale (NIHSS) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble protein-100 β (S100-β), which were used to construct a nomogram model. Conclusion The composite predictive model incorporating NIHSS score, hs-CRP, SII, NT-proBNP, and S100-β demonstrated efficacy in predicting POCD following AIS. Additionally, our results suggest a potential association between depth of anesthesia, cognitive impairment, and inflammatory response in AIS patients.
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Affiliation(s)
- Yangning Zhou
- Department of Anesthesiology, Shanghai United Family Hospital, Shanghai200050, China
| | - Yan Wang
- Department of Anesthesiology, Shanghai SinoUnited Hospital, No. 350 Middle Jiangxi Road, Shanghai200001, China
| | - Limin Xu
- Department of Anesthesiology, Shanghai United Family Hospital, Shanghai200050, China
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15
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Liu B, Wang P, Liang L, Zhu W, Zhang H. Effect of Remimazolam vs Midazolam on Early Postoperative Cognitive Recovery in Elderly Patients Undergoing Dental Extraction: A Prospective Randomized Controlled Study. Drug Des Devel Ther 2024; 18:5895-5904. [PMID: 39679137 PMCID: PMC11639880 DOI: 10.2147/dddt.s491223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 11/09/2024] [Indexed: 12/17/2024] Open
Abstract
Purpose Elderly patients undergoing dental extraction are particularly susceptible to delayed cognitive recovery after sedation. This study aimed to compare the effects of remimazolam and midazolam on early postoperative cognitive recovery in elderly patients undergoing dental extraction. Patients and Methods This was a single-centre randomized controlled study with elderly patients scheduled for receiving dental extraction under sedation of remimazolam (Group R) or midazolam (Group M). The primary outcome was postoperative cognitive recovery, as measured by the Montreal cognitive assessment 5-minute (MoCA 5-minute) 30 min postoperatively (T30). Secondary outcomes included MoCA 5-minute score 1 h postoperatively (T1h), incidence of post-extraction bleeding, intraoperative adverse events, success rate of sedation, time to discharge, and complications. Results 106 patients (53 in each group) were eligible for the study. At T30, MoCA 5-minute score was 25 (IQR 23.5, 27) in Group R, significantly higher than that of 23 (IQR 21, 25) in Group M (P < 0.001). This difference persisted at T1h [27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]. Group R also exhibited better hemostasis, with a lower post-extraction bleeding rate at T1 (5.67% vs 33.96%, χ2 = 13.36, P < 0.001). Group R showed significantly shorter times to peak sedation after the first dose of medication, awake time, and time to discharge compared to Group M (P < 0.001, P < 0.001, P < 0.001). Conclusion Remimazolam sedation significantly improves early postoperative cognitive recovery, leading to expedited hemostasis and a shorter discharge time.
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Affiliation(s)
- Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Peijuan Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Lirong Liang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Wei Zhu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Hui Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
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16
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Wang T, Wang QB, Hou ZJ, Chen W, Cheng H, He JK, Zhu LL, Wang YL, Chen YQ. Effect of serratus anterior plane block combined with oxycodone for transition analgesia on preventing emergence agitation after video-assisted thoracoscopic surgery: a randomized controlled trial. Sci Rep 2024; 14:30016. [PMID: 39623028 PMCID: PMC11612204 DOI: 10.1038/s41598-024-81801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 11/29/2024] [Indexed: 12/06/2024] Open
Abstract
Emergence agitation (EA) is more commonly observed after thoracic surgeries and can lead to serious complications. This study aimed to evaluate the effectiveness of serratus anterior plane block (SAPB) combined with oxycodone for transitional analgesia in preventing EA after video-assisted thoracoscopic surgery (VATS). A total of 121 adult patients scheduled for VATS under one-lung ventilation anesthesia were enrolled and randomly divided into three groups: preoperative SAPB without opioids for transitional analgesia near the end of the surgery (SAPB + SAL group, n = 39); preoperative SAPB with sufentanil at 0.1 µg/kg for transitional analgesia (SAPB + SF group, n = 42); and preoperative SAPB with oxycodone at 0.1 mg/kg for transitional analgesia (SAPB + OCD group, n = 40). In primary outcomes, the incidences of EA in the SAPB + SAL, SAPB + SF, and SAPB + OCD groups were 38.5%, 28.6%, and 7.5% respectively. There was a statistically significant difference in EA incidence between the SAPB + OCD and SAPB + SF groups (P = 0.0136). In secondary outcomes, compared to the SAPB + SF group, the SAPB + OCD group experienced shorter tracheal extubation time [15(9, 25) min vs. 21.5(14.5, 32.5) min; P = 0.0473] and PACU stay [67.5(55.0, 85.0) min vs. 87.5(70.0, 110.0) min; P = 0.0026]; lower NRS scores at 15 min and 2 h post-extubation (P < 0.01), and higher Quality of Recovery-15 (QoR-15) scores post-surgery [113(98, 123) vs. 102(88, 112); P = 0.0122]. Our results suggest SAPB combined with oxycodone for transitional analgesia, compared with sufentanil, is more effective in preventing EA after VATS and conductive to rapid recovery postoperatively.Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2300077473, Date: 09/11/2023.
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Affiliation(s)
- Tao Wang
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Qiu-Bo Wang
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Zi-Jun Hou
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Wei Chen
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Hao Cheng
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Jian-Kang He
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Ling-Li Zhu
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China
| | - Yu-Long Wang
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China.
| | - Yong-Quan Chen
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, China.
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Tao QY, Liu D, Wang SJ, Wang X, Ouyang RN, Niu JY, Ning R, Yu JM. Effects of Esketamine Combined with Dexmedetomidine on Early Postoperative Cognitive Function in Elderly Patients Undergoing Lumbar Spinal Surgery: A Double-Blind Randomized Controlled Clinical Trial. Drug Des Devel Ther 2024; 18:5461-5472. [PMID: 39624770 PMCID: PMC11611514 DOI: 10.2147/dddt.s481173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is a common complication after surgery in elderly patients, and its prevalence can be up to 25.6% at one week after noncardiac surgery. This study mainly evaluates the combined effects of esketamine and dexmedetomidine on the incidence of POCD in elderly patients undergoing lumbar spine surgery and explores the underlying mechanisms. Methods A total of 162 elderly patients undergoing lumbar spine surgery were randomized into three groups: esketamine combined with dexmedetomidine group (ED group), esketamine group (E group), and dexmedetomidine group (D group). Primary outcome measures included the incidence of POCD on the first postoperative day. Secondary outcomes included the incidence of POCD on the third postoperative day, first postoperative day serum levels of neuron-specific enolase (NSE) and calcium-binding protein β (S100β), patient visual analog scale (VAS) scores at 2, 24, and 48 hours postoperatively, and the incidence of adverse events. Results The incidence of POCD on the first postoperative day was significantly lower in the ED group compared to the E group (P = 0.017), with no significant differences when compared to the D group (P = 0.064). The levels of serum NSE in patients in the ED group on the first postoperative day were significantly lower than those in E group and D group (ED group vs E group, P = 0.028; ED group vs D group, P = 0.048). The results for the S100β were similar to those for the NSE (ED group vs E group, P = 0.005; ED group vs D group, P = 0.011). Conclusion The combination of esketamine and dexmedetomidine effectively reduces the incidence of POCD on the first postoperative day in elderly patients undergoing lumbar spine surgery.
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Affiliation(s)
- Qing-Yu Tao
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Dong Liu
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Shi-Jie Wang
- Department of Orthopaedics, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Xu Wang
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Rui-Ning Ouyang
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Jing-Yi Niu
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Rende Ning
- Department of Orthopaedics, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
| | - Jun-Ma Yu
- Department of Anaesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, 230061, People’s Republic of China
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Hu X, Zhu S, Yang X, Shan M, Wang J, Da X, Gui Y, Liu Y, Yang R, Xu G. Association Between Preoperative Lymphocyte-to-Monocyte Ratio and Occurrence of Postoperative Cognitive Dysfunction: A Prospective Cohort Study. J Inflamm Res 2024; 17:9527-9537. [PMID: 39600683 PMCID: PMC11590630 DOI: 10.2147/jir.s481106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024] Open
Abstract
Purpose Postoperative cognitive dysfunction (POCD) is a common postoperative complication. Studies have reported that lymphocyte-to-monocyte ratio (LMR) was a predictor of many diseases associated with inflammation. However, further examination of the relationship between preoperative LMR and POCD is needed. We aimed to investigate the association between POCD and preoperative LMR levels to examine the potential of LMR to predict POCD. Patients and Methods This was a prospective cohort study that included patients who underwent elective major abdominal surgery at our hospital between January 2019 and January 2022. Multivariate logistic regression analysis was used to analyze the effects of preoperative LMR on POCD development. The optimal threshold of preoperative LMR for predicting POCD was determined by receiver operating characteristic (ROC) approach. A subgroup analysis was performed according to age, sex, type of surgery and hypertension. Results Of 964 patients, 362 (37.6%) developed POCD. The preoperative LMR level in the Non-POCD group was higher than that in the POCD group. According to the ROC curve, a cutoff value of 3.758 of the preoperative LMR level could be used to predict POCD occurrence and the area under the curve (AUC) was 0.747 (95% CI: 0.715-0.779, P < 0.001). The results of the subgroup analyses were consistent with the primary ones, and no heterogeneity was observed in the subgroup analyses (P for interaction > 0.05). Conclusion LMR was significantly associated with the occurrence of POCD after major abdominal surgery. Preoperative low LMR levels can be used to identify patients who may be at high risk of POCD.
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Affiliation(s)
- Xudong Hu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Sihui Zhu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Xiao Yang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Menglei Shan
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Jiawei Wang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Xin Da
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Yongkang Gui
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Yang Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Rui Yang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
| | - Guanghong Xu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, People’s Republic of China
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Elias MH, Abdul Hamid N, Maluin SM, Aris S, Kadiman S, Muhammad Hafidz K, Juliana N. Preoperative Protein Profiling Among Postoperative Cognitive Dysfunction (POCD) Patients Following Open-Heart Surgery: A Systematic Review and Integrated Bioinformatic Analysis. Int J Mol Sci 2024; 25:12238. [PMID: 39596303 PMCID: PMC11595097 DOI: 10.3390/ijms252212238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/30/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024] Open
Abstract
The inability to accurately predict the occurrence of postoperative cognitive dysfunction (POCD) among open-heart surgery patients leads to concerning increases in POCD cases. Preoperative circulating biomarkers are important to identify as they are non-invasive and could provide an early prediction of POCD development, allowing for earlier and more strategized interventions. However, to date, no robust circulating biomarkers have proven effective for preoperative POCD prediction. This systematic review aims to synthesize current evidence on preoperative protein profiling among POCD patients following open-heart surgery. Thus, a thorough literature search employing PubMed, EBSCOhost, Scopus, and Science Direct was carried out. This combination of keywords was used as part of the search strategy: ("Postoperative cognitive decline" OR "Postoperative cognitive disorders" OR "Postoperative cognitive dysfunction" OR "Postoperative cognitive complications") AND ("Thoracic Surgery" OR "Cardiac Surgery" OR "Heart Surgery") AND ("Protein expression" OR proteomic OR "Protein profiling"). Eight hundred and twenty-nine studies were retrieved and only clinical studies reporting the circulating preoperative differentially expressed Proteins (DEPs) in the POCD patients were selected. Six studies were selected following the inclusion and exclusion criteria. Only one preoperative DEP and four immediate postoperative DEPs were extracted from the studies. All four proteins were selected for analysis using DAVID, STRING, and Cytoscape software. Due to the very low number of proteins, no clusters have been identified. This systematic review demonstrates the lack of POCD preoperative biomarkers for open-heart-surgery patients. Thus, it is suggested that more studies can be conducted to fill this gap.
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Affiliation(s)
- Marjanu Hikmah Elias
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Negeri Sembilan, Malaysia; (M.H.E.); (N.A.H.); (S.M.M.); (S.A.)
| | - Nazefah Abdul Hamid
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Negeri Sembilan, Malaysia; (M.H.E.); (N.A.H.); (S.M.M.); (S.A.)
| | - Sofwatul Mokhtarah Maluin
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Negeri Sembilan, Malaysia; (M.H.E.); (N.A.H.); (S.M.M.); (S.A.)
| | - Shamsir Aris
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Negeri Sembilan, Malaysia; (M.H.E.); (N.A.H.); (S.M.M.); (S.A.)
| | - Suhaini Kadiman
- Department of Anaesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (S.K.); (K.M.H.)
| | - Kamilah Muhammad Hafidz
- Department of Anaesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (S.K.); (K.M.H.)
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Negeri Sembilan, Malaysia; (M.H.E.); (N.A.H.); (S.M.M.); (S.A.)
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20
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Fan CH, Zeng XQ, Feng RM, Yi HW, Xia R. Comprehensive review of perioperative factors influencing ferroptosis. Biomed Pharmacother 2024; 179:117375. [PMID: 39278186 DOI: 10.1016/j.biopha.2024.117375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/18/2024] Open
Abstract
The perioperative period encompasses all phases of patient care from the decision to perform surgery until full recovery. Ferroptosis, a newly identified type of regulated cell death, influences a wide array of diseases, including those affecting the prognosis and regression of surgical patients, such as ischemia-reperfusion injury and perioperative cognitive dysfunction. This review systematically examines perioperative factors impacting ferroptosis such as surgical trauma-induced stress, tissue hypoxia, anesthetics, hypothermia, and blood transfusion. By analyzing their intrinsic relationships, we aim to improve intraoperative management, enhance perioperative safety, prevent complications, and support high-quality postoperative recovery, ultimately improving patient outcomes.
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Affiliation(s)
- Cheng-Hui Fan
- Department of Anaesthesiology, the First Affiliated Hospital of Yangtze University, Jingzhou 434000, PR China
| | - Xiao-Qin Zeng
- Department of Anaesthesiology, The Second People's Hospital of Jingzhou, Jingzhou 434020, PR China
| | - Rui-Min Feng
- Laboratory Department, the First Affiliated Hospital of Yangtze University, Jingzhou 434000, PR China
| | - Hua-Wei Yi
- Laboratory Department, the First Affiliated Hospital of Yangtze University, Jingzhou 434000, PR China.
| | - Rui Xia
- Department of Anaesthesiology, the First Affiliated Hospital of Yangtze University, Jingzhou 434000, PR China.
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21
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Wang T, Sun G, Tao B. Updated insights into the NLRP3 inflammasome in postoperative cognitive dysfunction: emerging mechanisms and treatments. Front Aging Neurosci 2024; 16:1480502. [PMID: 39411285 PMCID: PMC11474915 DOI: 10.3389/fnagi.2024.1480502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Postoperative cognitive dysfunction (POCD) poses a significant threat to patients undergoing anesthesia and surgery, particularly elderly patients. It is characterized by diminished cognitive functions post surgery, such as impaired memory and decreased concentration. The potential risk factors for POCD include age, surgical trauma, anesthetic type, and overall health condition; however, the precise mechanisms underlying POCD remain elusive. Recent studies suggest that neuroinflammation might be a primary pathogenic factor. NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasomes are implicated in exacerbating POCD by promoting the release of inflammatory factors and proteins that initiate pyroptosis, further influencing the disease process. The regulation of NLRP3 inflammasome activity, including its activation and degradation, is tightly controlled through multiple pathways and mechanisms. In addition, autophagy, a protective mechanism, regulates the NLRP3 inflammasome to control the progression of POCD. This review reviews recent findings on the role of the NLRP3 inflammasome in POCD pathogenesis and discusses therapeutic strategies aimed at reducing NLRP3 sources, inhibiting cellular pyroptosis, and enhancing autophagy.
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Affiliation(s)
| | | | - Bingdong Tao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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22
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Wen Y, Zhang W, Wang D, Lu M. Propofol ameliorates cognitive deficits following splenectomy in aged rats by inhibiting ferroptosis via the SIRT1/Nrf2/GPX4 pathway. Neuroreport 2024; 35:846-856. [PMID: 38968575 DOI: 10.1097/wnr.0000000000002074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
The aim of this study was to investigate the mechanism by which propofol reduces postoperative cognitive dysfunction after splenectomy in aged rats. The rats in the model group and propofol group were subjected to splenectomy, and anesthetized with isoflurane and propofol, respectively. Utilizing the western blotting to assess the expression of sirtuin-1 (SIRT1) in the hippocampus. Molecular docking technology was used to predict the binding ability of propofol and SIRT1. Behavioral tests were performed using the Morris water maze, and the hippocampus was isolated for mechanistic investigations. Molecular docking showed that propofol and SIRT1 had a strong binding affinity. The expression of SIRT1 and its related proteins Nrf2, HO-1, NQO1, and GPX4 in the model rats was decreased compared with the sham group. Moreover, the model group exhibited cognitive decline, such as extended escape latency and decreased number of platform crossings. Pathological analysis showed that the number of apoptotic neurons, the levels of oxidative stress and neuroinflammation, the iron deposition, and the expressions of ACSL4 and TFR1 were increased, while the expressions of SLC7A11 and FTH1 were decreased in the hippocampal CA1 region within the model group. These pathological changes in the propofol group were, however, less than those in the model group. Nevertheless, the SIRT1 inhibitor increased these pathological changes compared with the propofol group. Compared with isoflurane, propofol inhibits ferroptosis in the hippocampus of splenectomized rats by causing less downregulation of the SIRT1/Nrf2/GPX4 pathway, thereby reducing the negative impact on cognitive function.
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Affiliation(s)
| | - Weihua Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu City, China
| | - Dingran Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu City, China
| | - Meijing Lu
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu City, China
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23
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Yang S, Xu Y, Ahmad T, Deng Q, Gan Z, Yang Y, Yun H, Dong Z, Tu S. Mdivi-1 alleviates ferroptosis induced by hypoxia combined with propofol in HT22 cells by inhibiting excessive mitophagy. Mol Biol Rep 2024; 51:870. [PMID: 39080104 DOI: 10.1007/s11033-024-09812-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/19/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND Pediatric postoperative cognitive dysfunction (POCD) is a prevalent complication following anesthesia and surgery. Hypoxia and propofol are the primary risk factors contributing to pediatric POCD. Our previous in vivo animal research has demonstrated that cognitive dysfunction in immature Sprague-Dawley (SD) rats, induced by hypoxia combined with propofol (HCWP), is closely associated with hippocampal neuron ferroptosis. METHODS AND RESULTS In vivo transcriptome sequencing and KEGG functional analysis revealed significant enrichment of the mitophagy pathway. To further elucidate the relationship between mitophagy and ferroptosis, HT22 cells were selected to construct an in vitro HCWP model. Our findings indicate that HCWP activates excessive mitophagy in HT22 cells, leading to decreased mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS) burst, mitochondrial fragmentation, and the induction of ferroptosis. To explore this causal relationship further, we employed Mdivi-1, a mitophagy inhibitor. Notably, low-dose Mdivi-1 (10 µM) effectively suppressed excessive mitophagy in HT22 cells, improved mitochondrial function and morphology, and mitigated markers associated with ferroptosis. The mechanism by which Mdivi-1 alleviates HCWP-induced ferroptosis in HT22 cells is likely due to its inhibition of excessive mitophagy, thereby promoting mitochondrial homeostasis. CONCLUSIONS Our study suggests that mitophagy may be an upstream event in HCWP-induced ferroptosis in HT22 cells. Consequently, targeted regulation of mitophagy by Mdivi-1 may represent a promising approach to prevent cognitive dysfunction following HCWP exposure.
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Affiliation(s)
- Shun Yang
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Yao Xu
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Tauseef Ahmad
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Qianyu Deng
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Zhengwei Gan
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Ying Yang
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Huanjie Yun
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Zhifang Dong
- Growth, Development, and Mental Health of Children and Adolescence Center, Pediatric Research Institute, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Shengfen Tu
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
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24
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Liu L, Gao W, Yang S, Yang F, Li S, Tian Y, Yang L, Deng Q, Gan Z, Tu S. Ferritinophagy-Mediated Hippocampus Ferroptosis is Involved in Cognitive Impairment in Immature Rats Induced by Hypoxia Combined with Propofol. Neurochem Res 2024; 49:1703-1719. [PMID: 38512425 DOI: 10.1007/s11064-024-04128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Propofol is a clinically common intravenous general anesthetic and is widely used for anesthesia induction, maintenance and intensive care unit (ICU) sedation in children. Hypoxemia is a common perioperative complication. In clinical work, we found that children with hypoxemia who received propofol anesthesia experienced significant postoperative cognitive changes. To explore the causes of this phenomenon, we conducted the study. In this study, our in vivo experiments found that immature rats exposed to hypoxia combined with propofol (HCWP) could develop cognitive impairment. We performed the RNA-seq analysis of its hippocampal tissues and found that autophagy and ferroptosis may play a role in our model. Next, we verified the participation of the two modes of death by detecting the expression of autophagy-related indexes Sequestosome 1 (SQSTM1) and Beclin1, and ferroptosis-related indicators Fe2+, reactive oxygen species (ROS) and glutathione peroxidase 4 (GPX4). Meanwhile, we found that ferrostatin-1 (Fer-1), an inhibitor of ferroptosis, could improve cognitive impairment in immature rats caused by HCWP. In addition, we found that nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy, which acted as a key junction between autophagy and ferroptosis, was also involved. Finally, our in vitro experiments concluded that autophagy activation was an upstream factor in HCWP-induced hippocampus ferroptosis through the intervention of autophagy inhibitor 3-methyladenine (3-MA). Our study was expected to provide an attractive therapeutic target for cognitive impairment that occurred after HCWP exposures.
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Affiliation(s)
- Ling Liu
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Wen Gao
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Shun Yang
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Fei Yang
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Shangyingying Li
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Yaqiong Tian
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Li Yang
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Qianyu Deng
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Zhengwei Gan
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China
| | - Shengfen Tu
- Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing City, China.
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25
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Zhu X, Lin J, Yang P, Wu S, Lin H, He W, Lin D, Cao M. Surgery induces neurocognitive disorder via neuroinflammation and glymphatic dysfunction in middle-aged mice with brain lymphatic drainage impairment. Front Neurosci 2024; 18:1426718. [PMID: 38975244 PMCID: PMC11225229 DOI: 10.3389/fnins.2024.1426718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Background Brain lymphatic drainage impairment is a prevalent characteristic in both aging and neurodegeneration. Surgery is more likely to induce excessive neuroinflammation and postoperative neurocognitive disorder (PND) among patients with aging and neurodegeneration. We hypothesized that surgical trauma may aggravate PND through preexisting cerebral lymphatic drainage impairment. However, there remains limited understanding about the role of surgery in changes of neurocognitive function in the populations with preoperative brain lymphatic drainage impairment. This study aims to expand our insight into surgery-induced glymphatic dysfunction, neuroinflammation and PND in middle-aged mice with preoperative brain lymphatic drainage impairment. Materials and methods Deep cervical lymph nodes ligation (LdcLNs) was performed on middle-aged mice to establish preoperative brain lymphatic drainage impairment. A month later, laparotomy was performed on these mice with or without LdcLNs followed by analysis of brain neuroinflammation, glymphatic function, neuronal damage, and behavioral test. Results LdcLNs disrupted meningeal lymphatic drainage. In middle-aged mice with LdcLNs, surgery exacerbated more serious glymphatic dysfunction accompanied by aggravation of A1 astrocytes activation and AQP4 depolarization. Furthermore, surgery caused neuronal damage via reducing expression of neuronal nuclei (NeuN), post-synaptic density protein 95 (PSD95) and synaptophysin (SYP), as well as impairment in exploratory behavior and spatial working memory in middle-aged mice with LdcLNs. Additionally, surgery induced neuroinflammation with elevated microglia activation and increased the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6, as well as activated more expression of HMGB1/TLR-4/NF-κB pathway in middle-aged mice with LdcLNs. Conclusion Surgery exacerbates neuroinflammation and glymphatic dysfunction, ultimately resulting in neuronal damage and neurocognitive disorder in middle-aged mice with preoperative brain lymphatic drainage impairment. These results suggest that brain lymphatic drainage impairment may be a deteriorating factor in the progression of PND, and restoring its function may serve as a potential strategy against PND.
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Affiliation(s)
- Xiaoqiu Zhu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingrun Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pengfeng Yang
- Department of Ultrasound Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shaotao Wu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huijun Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen He
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daowei Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Fu Y, Wei Q, Wang Z, Zhao Q, Shi W. Effects of dexmedetomidine on postoperative pain and early cognitive impairment in older male patients undergoing laparoscopic cholecystectomy. Exp Ther Med 2024; 27:189. [PMID: 38533435 PMCID: PMC10964730 DOI: 10.3892/etm.2024.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
The primary aim of the present study was to investigate the effect of dexmedetomidine (DEX) on postoperative pain and early cognitive impairment in old male patients, who underwent laparoscopic cholecystectomy (LC). A total of 97 old patients, subjected to LC at the 980 Hospital of the Joint Service Support Force of the People's Liberation Army of China, were randomly divided into two groups, namely the DEX and normal saline groups. Patients in the DEX group received an intravenous infusion of 0.8 µg/kg DEX within 10 min following general anesthesia, followed by a maintenance infusion of 0.5 µg/(kg/h). Furthermore, patients in the normal saline group were treated with an equivalent volume of normal saline. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) tests at 6 h, 1, 2 and 3 days, postoperatively. The incidence of postoperative cognitive dysfunction (POCD) and postoperative adverse events were recorded for both groups. In addition, the Visual Analogue Scale (VAS) pain score was utilized to assess the pain level of all patients, while the Quality of Recovery-15 (QoR-15) scale was employed to analyze the postoperative recovery results. Therefore, the MoCA score was higher in the DEX group compared with the normal saline group at 6 h and day 1 postoperatively. Additionally, the MMSE score was higher at 6 h postoperatively in the DEX group compared with the normal saline group. Correspondingly, the incidence of POCD was lower in the DEX group compared with the normal saline group at 6 h and day 1, after LC (P<0.05). VAS score in resting state for patients in the DEX group was significantly lower compared with the normal-saline group (P<0.05). Furthermore, the QoR-15 scale score in patients in the DEX group was notably increased compared with the normal saline group on the first and second days after the operation (P<0.05). Overall, the present study verified that the continuous infusion of DEX at a rate of 0.5 µg/(kg/h) during LC could effectively reduce the incidence of early POCD and alleviate postoperative pain in old male patients, thus facilitating postoperative recovery.
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Affiliation(s)
- Yanlong Fu
- Department of Hepatobiliary Surgery, The 980 Hospital of The Joint Service Support Force of The People's Liberation Army of China, Shijiazhuang, Hebei 050000, P.R. China
| | - Qiang Wei
- Department of Hepatobiliary Surgery, The 980 Hospital of The Joint Service Support Force of The People's Liberation Army of China, Shijiazhuang, Hebei 050000, P.R. China
| | - Zhenliang Wang
- Department of Hepatobiliary Surgery, The 980 Hospital of The Joint Service Support Force of The People's Liberation Army of China, Shijiazhuang, Hebei 050000, P.R. China
| | - Qingtao Zhao
- Department of Hepatobiliary Surgery, The 980 Hospital of The Joint Service Support Force of The People's Liberation Army of China, Shijiazhuang, Hebei 050000, P.R. China
| | - Wenxin Shi
- Department of Hepatobiliary Surgery, The 980 Hospital of The Joint Service Support Force of The People's Liberation Army of China, Shijiazhuang, Hebei 050000, P.R. China
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27
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Huang J, Zhu X, Cao W, Guo X, Liu X. A commentary on 'Preventing postoperative cognitive dysfunction using anesthetic drugs in elderly patients undergoing noncardiac surgery: a systematic review and meta-analysis'. Int J Surg 2024; 110:2456-2457. [PMID: 38215265 PMCID: PMC11020141 DOI: 10.1097/js9.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/14/2024]
Affiliation(s)
| | | | | | | | - Xue Liu
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
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28
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Moonesinghe SR. Desflurane decommissioning: more than meets the eye. Anaesthesia 2024; 79:237-241. [PMID: 38207006 DOI: 10.1111/anae.16219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Affiliation(s)
- S R Moonesinghe
- University College London, London, UK
- Departments of Anaesthesia, Perioperative and Critical Care, University College London Hospitals, London, UK
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29
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Zhang A, Zhou Y, Zheng X, Zhou W, Gu Y, Jiang Z, Yao Y, Wei W. Effects of S-ketamine added to patient-controlled analgesia on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized double-blinded controlled trial. J Clin Anesth 2024; 92:111299. [PMID: 37939610 DOI: 10.1016/j.jclinane.2023.111299] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/22/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
STUDY OBJECTIVE To investigate whether the addition of S-ketamine to patient-controlled hydromorphone analgesia decreases postoperative moderate-to-severe pain and improves the quality of recovery (QoR) in patients undergoing thoracoscopic lung surgery. DESIGN Single-center prospective randomized double-blinded controlled trial. SETTING Tertiary university hospital. PATIENTS 242 patients undergoing thoracoscopic lung surgery. INTERVENTIONS Patients were randomized to receive intravenous patient-controlled analgesia (IV-PCA) with hydromorphone alone or hydromorphone combined with S-ketamine (0.5 mg/kg/48 h, 1 mg/kg/48 h, or 2 mg/kg/48 h). MEASUREMENTS Primary outcome was proportion of patients with moderate-to-severe pain. (numerical rating scale [NRS] pain scores ≥4 when coughing) within 2 days after surgery. Postoperative QoR scores and other prespecified outcomes were also recorded. MAIN RESULTS Of 242 enrolled patients, 220 were included in the final analysis. The results demonstrated that the incidence of postoperative moderate-to-severe pain was significantly different between the hydromorphone group and combined S-ketamine group (absolute difference, 27.9%; 95% confidence interval [CI], 11.7% to 42.1%; P < 0.001). Patients who received S-ketamine had lower NRS pain scores at rest and when coughing on postoperative day 1 (POD1; median difference 1 and 1, P < 0.001) and postoperative day 2 (POD2; median difference 1 and 1, P < 0.001). The QoR-15 scores were higher in the combined S-ketamine group on POD1 (mean difference 6, P < 0.001) and POD2 (mean difference 6, P < 0.001) than in the hydromorphone group. A higher dose of S-ketamine was associated with deeper sedation. No differences were detected in the other safety outcomes. CONCLUSIONS Addition of S-ketamine to IV-PCA hydromorphone significantly reduced the incidence of postoperative moderate-to-severe pain and improved the QoR in patients undergoing thoracoscopic lung surgery. TRIAL REGISTRATION Chinese Clinical Trail Register (identifier: ChiCTR2200058890).
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Affiliation(s)
- Anyu Zhang
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Yongxin Zhou
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Xi Zheng
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Weichao Zhou
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Yu Gu
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Zeyong Jiang
- Department of Thoracic Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Yonghua Yao
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Wei Wei
- Department of Anesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China.
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Yu J, Tang W, Sulaiman Z, Ma X, Wang J, Shi Z, Liu Q, Xie Z, Shen Y. The Association Between Surgery and Mild Cognitive Impairment: Insight from a Case-Control Study. J Alzheimers Dis 2024; 100:1379-1388. [PMID: 39031365 DOI: 10.3233/jad-240467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Surgery may be associated with postoperative cognitive impairment in elder participants, yet the extent of its association with mild cognitive impairment (MCI) remains undetermined. Objective To determine the relationship between surgery and MCI. Methods The data of participants from the Alzheimer's Disease Neuroimaging Initiative were analyzed, including individuals with MCI or normal cognition. We focused on surgeries conducted after the age of 45, categorized by the number of surgeries, surgical risk, and the age at which surgeries occurred. Multivariable logistic regression was employed to determine the association between surgery and the development of MCI. Results The study is comprised of 387 individuals with MCI and 578 cognitively normal individuals. The overall surgery exposure (adjusted OR = 1.14, [95% CI 0.83, 1.56], p = 0.43) and the number of surgeries (adjusted OR = 0.92 [0.62, 1.36], p = 0.67 for single exposure, adjusted OR = 1.12 [0.71, 1.78], p = 0.63 for two exposures, adjusted OR = 1.38 [0.95, 2.01], p = 0.09 for three or more exposures compared to no exposure as the reference) were not associated with the development of MCI. However, high-risk surgeries (adjusted OR = 1.79 [1.00, 3.21], p = 0.049) or surgeries occurring after the age of 75 (adjusted OR = 2.01 [1.03, 3.90], p = 0.041) were associated with a greater risk of developing MCI. Conclusions High risk surgeries occurring at an older age contribute to the development of MCI, indicating a complex of mechanistic insights for the development of postoperative cognitive impairment.
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Affiliation(s)
- Jian Yu
- Department of Psychiatry, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Wenyu Tang
- Department of Psychiatry, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Zubaidan Sulaiman
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Department of Psychiatry, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Wang
- Department of Psychiatry, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Zhongyong Shi
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qidong Liu
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Yuan Shen
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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