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Objective To investigate the effect of ultrasound-guided quadratus lumborum block on cognitive function after laparoscopic colorectal surgery.Methods Seventy-six patients, there is no restriction on gender, aged 50-75 years, falling into ASA physical statusⅡorⅢ, who provided informed consent for their participation in this study and underwent colorectal surgery under general anesthesia were divided into two groups (groups Q and C).Induction of anesthesia was induced by intravenous midazolam 0.03 mg/kg, sufentanil 0.5μg/kg, etomidate 0.3 mg/kg and rocuronium 1 mg/kg in the two groups.Remifentanil 0.2-0.3μg·kg-1·min-1 and propofol 0.10-0.15 mg·kg-1·min-1 were maintained intravenously during anesthesia.0.375％ropivacaine 20 ml was injected between the psoas quadratus muscle and psoas major muscle under ultrasound guidance before extubation in group Q, only equal volume saline was given in group C.Neuropsychological tests were performed preoperatively as well as postoperative day 7.The postoperative pain was evaluated by VAS after surgery.The postoperative sleep quality was measured using a BIS-vista monitor.The changes of serum IL-6, IL-1β, TNF-αand CGRP levels were detected by ELISA at immediately after operation (T0), 1 hour (T1), 2 days (T2), 4 days (T3) and 7 days (T4) after operation.Results Seventy-six patients finished cognitive function tests (38 cases in group Q and 38 cases in group C), 12 cases (31.6％) were diagnosed as POCD in group C, 4 cases (10.5％) in group Q.Compared with group C, the incidence of POCD, VAS scores at 24 and 48 hours after operation in group Q were significantly lower (P<0.05), the sleeping time at night was longer, the serum levels of IL-6, IL-1βand TNF-αwere significantly lower at T2 and T3, and the serum levels of CGRP were significantly higher at T2-T4 (P<0.05 or P<0.01).Conclusion QLB treatment repaired the surgery induced early cognitive dysfunction by inhibiting the postoperative pain, excessive inflammatory response and improving the quality of sleep.
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Objective To investigate the effect and mechanisms of pioglitazone on post operative cognitive function induced by surgery in elderly rats.Methods Elderly SD rats,male and weighing 220-250 g,were randomly divided into control group (group Con),surgery group (group S),pioglitazone group (group P)and pioglitazone/surgery group (group PS).The level of glycemia was measured by glucometer after completing the surgical model.The expression of advanced glycation endproducts (AGEs)in hippocampal tissues was detected by western blot and reactive oxy-gen species (ROS)and IL-6 by ELISA 1 2 h after surgery.Morris water maze was used for evaluation of cognitive function 4 days after surgery.Results Compared with group Con,group S showed a sig-nificant increase in the expression of AGEs and IL-6 and the level of ROS (P<0.05);Compared with group S,the expression of AGEs and IL-6 and the level of ROS decreased significantly in group PS (P<0.05).Compared to group Con,the surgery increased the average time of escape latencies on the 8th days and 10th days after surgery and reduced the platform-crossing times in the Morris water maze test (P<0.05).Compared with group S,group PS showed a significant decrease in the average time of escaping latencies on the 10th day after surgery (P<0.05),and an increased platform-cross-ing times in the Morris water maze test (P<0.05).Conclusion These results suggest that pioglita-zone attenuates postoperative cognitive function and its mechanism may be related to the decrease of the expression of AGEs and IL-6 and the level of ROS.
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Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on postoperative cognitive function in the patients undergoing thoracic surgery.Methods One hundred and twenty patients undergoing lung cancer thoracotomic radical resection were randomly divided into hydrochloride penehyclidine composite ulinastatin group(HU group),hydrochloride penehyclidine group(H group),ulinastatin group(U group)and control group(C group).The arterial blood was collected for detecting OI,TNF-α,IL-6 and IL-8.The serum levels of S-100β and NSE were detected.The MMSE scores were evaluated.Results Compared with the H group and U group,the levels of TNF-α at T3-4 in the HU group were decreased,and the levels of IL-6 and IL-8 at T2-4 were decreased,while OI was increased(P＜0.05).Compared with the H group and U group,the serum levels of S-100β and NSE at T5-8 in the HU group were decreased(P＜0.05);compared with the H group and U group,the MMSE scores at T6-7 in the HU group were increased(P＜0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin could reduce the inflammation reaction during one lung ventilation in thoractomy and improves the postoperative cognitive function.
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Objective To investigate the impact of ethyl pyruvate (EP) on cognitive function and the expression of high mobility group box 1 (HMGB1) and receptor for advanced glycation end products (RAGE) after splenectomy in aged rats.Methods Eighty-four male aged Sprague-Dawley rats, 18 months old, weighing 500-600 g, were randomly divided into 4 groups (n=21 each) by random number table method: control group (group C), surgery group (group S) ethyl pyruvate group (group E) and solution without EP group (group R).Morris water maze test was performed to evaluate cognitive function 5 days before surgery and 1, 3, 7 days after surgery.Group E was injected with EP 40 mg/kg intrapertoneally after splenectomy, group S and group C were injected with equivalent normal saline after splenectomy, group R was injected with equivalent solution without EP.Rats were killed after Morris water maze test, and the expression of HMGB1 and RAGE protein and mRNA in hippocampus were measured by Western blot and RT-PCR methods.Results Compared with group C, the escape latency and swimming distance were significantly prolonged in groups S, E and R 1 and 3 days after surgery, as well as the expression of HMGB1 and RAGE in hippocampus were significantly up-regulated (P＜0.05).Compared with group S, the escape latency and swimming distance were significantly decreased and the expression of HMGB1 and RAGE were down-regulated in group E 1 and 3 days after surgery (P＜0.05).Compared with the preoperative group, the escape latency and swimming distance were significantly prolonged in groups S, E and R 1 and 3 days after surgery (P＜0.05).Conclusion EP may improve cognitive function in aged rats by down regulating the expression of HMGB1 and RAGE in the hippocampus.
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Objective To investigate the effects of sevoflurane and propofol on postoperative cognitive function after abdominal surgery for elderly patients with diabetes. Methods Seventy diabetic patients (aged 60~75 yr, ASAⅠorⅡ) underwent abdominal surgery and are included in the research. Diabetic patients were randomly divided into two groups (n=35): sevoflurane group(group DS) and propofol group (group DP). MMSE score, the attachment test, words memory test and Stroop color word test were carried and the results were recorded before operation (T1), postoperative 24 h (T2), 48 h (T3) and 1 w (T4). Results Compared with T1, patients′ MMSE score reduced at T2 and T3. Time spent in attachment test is longer at T2 and T3. Mistaken incidences in Stroop color words test 1, 2 and 3 are higher and time longer at T2. Time spent on Stroop color words test 2 and 3 is longer in T3. Words memory test reveals decline at T2 and T3, whose difference is statistically significant (P 0.05). Conclusion Sevoflurane and propofol can result in postoperative cognitive dysfunction for elderly patients with diabetes within 48 h after abdominal surgery, there were no difference between the effects of them.
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Objective To investigate the effects of a variety of different methods of analgesia on postoperative pain and cognitive function in elderly esophageal cancer patients.Methods Sixty elderly pa-tients scheduled for the left into the thoracic esophageal cancer surgery were randomly divided into two groups (n =30).Group A:Before the closure of thoracic cavity to block intercostal nerve with 0.375% rop-ivacaine,followed by intravenous pumps for analgesia,formulation of sufentanil 3 μg/kg+flurbiprofen 100 mg,pump speed 2 ml/h,self-controlled analgesia 0.5 ml/pressing,locking time 15 min.Group B:Before the closure of thoracic cavity given sufentanil 10 μg+flurbiprofen 50 mg as loading dose followed by epidural analgesia pump,recipe with group A.Two groups were observed mini mental state examination (MMSE) score 1 d before surgery and 3,5,7 d after surgery,each time point visual analogue pain score (resting and exercise VAS)score postoperative within 48 h,BCS comfort score and effective pressing times of postopera-tive analgesia pump.Results Compared with group B,the rest and exercise VAS scores of group A at post-operative recovery,4,8,12,24,48 h were significantly lower (P <0.05);the BCS scores of group A at postoperative 4,8,12,24,48 h were significantly higher (P <0.05);the pressing times of group A at postoperative 4,8,12,24,48 h were significantly reduced (P <0.05);the MMSE scores of group A at postoperative 3,5,7 d were significantly higher (P <0.05);the incidence of POCD of group A on postop-erative 3,5,7 d were significantly lower.Conclusion Thoracic surgery perioperative multimodal analgesia (intercostal nerve block and intravenous analgesia)can relieve postoperative pain,reduce the incidence of POCD,improve the postoperative patient comfort and help postoperative patients with rapid recovery.
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Objective To explore the relationship of perioperative INVOS cerebral oxygen saturation (rSO2) and postoperative cognition function alteration of geriatric patients under combined intravenous and volatile anesthesia with creatine phosphate disodium to provide guidance for clinical anesthesia. Methods Sixty ASA I-II patients aged >60 years scheduled for selective abdominal surgeries or surgeries on lower limb were enrolled in the study. The patients were randomly divided into 3 groups of 20 patients: creatine phosphate disodium group 1 (CPD1), creatine phosphate disodium group 2 (CPD2), control group (C). All the patients were not premedicated with atropine 0.5mg until entering the operation room. Anesthesia was induced with intravenous infusion of propofol, fentanyl and cisatracurium slowly, and maintained by inhalational anesthetics sevoflurane 1 MAC plus intravenous infusion of propofol (6-8mg·kg-1·min-1) and remifentanyl (0.2-0.4μg·kg-1·min-1), and intravenous bolus cisatracurium (0.07-0.10mg·kg-1). After tracheal intubation, all the patients were mechanically ventilated with PETCO2 in the normal range. rSO2 was continuously monitored and recorded during the operation. The Mini-Mental State Examination (MMSE), Trailmaking Test and Grooved Pegboard Test were used to access cognitive function 24h before surgery and 4, 8, 12, 24h after surgery. Results (1) There were no significant differences in general status between the three groups (P>0.05). (2) The scores of MMSE, Trail-making Test and Grooved Pegboard Test were not different 24h before the operation between the three groups (P>0.05). (3) The scores of cognitive tests were higher in group CPD2 and group CPD1 than in group C (P0.05). Conclusion CPD can reduce the occurrence of postoperative cognitive dysfunction in geriatric patients under combined intravenous and inhalational anesthesia.
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BACKGROUND: Laparoscopic gastrectomy requires a reverse-Trendelenburg position and prolonged pneumoperitoneum and it could cause significant changes in cerebral homeostasis and lead to cognitive dysfunction. We compared changes in regional cerebral oxygen saturation (rSO2), early postoperative cognitive function and hemodynamic variables in patients undergoing laparoscopic gastrectomy with those patients that underwent conventional open gastrectomy. METHODS: Sixty patients were enrolled in this study and the patients were distributed to receive either laparoscopic gastrectomy (laparoscopy group, n = 30) or open conventional gastrectomy (open group, n = 30). rSO2, end-tidal carbon dioxide tension, hemodynamic variables and arterial blood gas analysis were monitored during the operation. The enrolled patients underwent the mini-mental state examination 1 day before and 5 days after surgery for evaluation of early postoperative cognitive function. RESULTS: Compared to baseline value, rSO2 and end-tidal carbon dioxide tension increased significantly in the laparoscopy group after pneumoperitoneum, whereas no change was observed in the open group. No patient experienced cerebral oxygen desaturation or postoperative cognitive dysfunction. Changes in mean arterial pressure over time were significantly different between the groups (P < 0.001). CONCLUSIONS: Both laparoscopic and open gastrectomy did not induce cerebral desaturation or early postoperative cognitive dysfunction in patients under desflurane anesthesia. However, rSO2 values during surgery favoured laparoscopic surgery, which was possibly related to increased cerebral blood flow due to increased carbon dioxide tension and the effect of a reverse Trendelenburg position.
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Humans , Anesthesia , Arterial Pressure , Blood Gas Analysis , Carbon Dioxide , Gastrectomy , Head-Down Tilt , Hemodynamics , Homeostasis , Laparoscopy , Oxygen , PneumoperitoneumABSTRACT
Objective To integrative the effect of ulinastatin on postoperative cognitive function in elderly gastric cancer surger-y.Methods Two hundred elderly patients with gastric cancer surgery were randomly divided into observed group (100 cases)and control group (100 cases).Patients in observed group received the intravenous drip of ulinastatin before and after the surgery,while others only received the intravenous drip of physiological saline before and after the surgery.Results The urine output of observed group was (441.7±78.5)mL,which was significantly lower than that in control group as the result was (613.2±81.2)mL(P <0.05).After the treatment,the score of MMSE,visual regeneration and association learning in both observed group and control group were significantly lower than that before the treatment(P <0.05).The scores of MMSE,visual regeneration and association learning in observed group were 24.4±1.5,9.7±1.7 and 12.4±1.8,which were significantly higher than that in control group as the scores were 21.1±1.0,8.7±1.5 and 11.3±1.7 (P <0.05).The level of S100βin serum of observed group at the end of sur-gery,1 day and 3 day after the surgery were (0.099±0.024)μg/L,(0.074±0.026)μg/L and (0.061±0.022)μg/L,which were significantly lower than that in control group as the results were (0.138±0.042)μg/L,(0.110±0.034)μg/L and (0.075±0.031)μg/L (P < 0.05).Conclusion Ulinastatin can not only improve the postoperative cognitive dysfunction in elderly patients with postoperative,but can also reduce the level of S100βin serum.It provides brain protection for patients.
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Objective:To explore the exploratory application Dezocine analgesics for older surgical patients preemptive analgesia for patients after surgery cognitive function.Methods: March 2011 to August 2013 in our hospital undergoing elective hip replacement surgery in elderly patients 180 cases were randomly divided into a control group and the test group, 90 cases in each group. Elderly patients before anesthesia injection 5mg each test group of Dezocine liquid; as the control group were injected normal saline injection; After all patients systemic anesthesia. Before and after surgery were done at different times for the mini-mental state examination two groups of patients (MMSE) test, plasma cortisol concentration detection and dysfunction (POCD) in the overall proportion of patients in each group postoperative cognitive happen.Results: Compared to the control group, the experimental group of elderly patients with preoperative and postoperative MMSE scores were higher; and its concentration in plasma cortisol decreased; experimental group POCD occurred in the proportion of elderly patients accounted for 19%, compared with the control group 32% slightly slight lower. Conclusion: Dezocine preemptive analgesia in elderly patients undergoing certain aspects of the application has a positive effect, reduce patient postoperative pain, reduce the risk of postoperative cognitive dysfunction in the elderly.
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Objective To observe the impacts of lumbar plexus block combined with sciatic nerve block on postoperative cognitive function and plasma S100βlevel in eldly patients undergoing hip surgeries.Methods Sixty patients of ASA Ⅱ or Ⅲ aged 65-85 years,undergoing selective hip sur-geries,were randomly divided into 2 groups (n=30 each).Group G received general anesthesia with tracheal intubation,while group L received ultrasound-guided lumbar plexus block and parasacral sci-atic nerve block combined with general anesthesia.The mini-mental state examination (MMSE)score was recorded before anesthesia,1 d,3 d and 7 d after operation.The plasma S100βlevel was detected before anesthesia,1 h and 7 d after operation.Results The MMSE scores declined on 1 d after oper-ation in both groups(P <0.05),and the value was lower in group G(P <0.05).There were 18 (56.7%)patients diagnosed with POCD in group G at the first day postoperatively,while it was 10 (33.3%)in group L,and the difference was significant(P<0.05).The MMSE scores were still low-er at 3 d after operation (P<0.05).The concentrations of plasma S100βincreased in both groups at 1 h after operation,and it was more obviously in group G (P <0.05).Conclusion Lumbar plexus block combined with parasacral sciatic nerve block might reduce the stress reaction and dosages of general anesthetics in eldly patients undergoing hip surgeries,minimize the damages of central nervous system,protect the cognitive function and reduce the incidence of POCD.