This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rohan, D. Articles by Moriarty, D. C. Search for Related Content PubMed PubMed Citation Articles by Rohan, D. Articles by Moriarty, D. C.

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly

[Incidence accrue de dysfonctionnement cognitif 24 h après une operation mineure chez des gens âgés]

Denise Rohan, FCARCSI^*, Donal J. Buggy, MD MSc DME FRCPI FCARCSI FRCA^*,, Seamus Crowley, FCARCSI^*, Ferraby K. H. Ling^*, Helen Gallagher, PhD^*, Ciaran Regan^* and Denis C. Moriarty, FCARCSI FRCA^*

^* From the Division of Anesthesia, Mater Misericordiae Hospital, National University of Ireland, Dublin, Ireland; and
the Outcomes Research Institute,^TM Louisville, Kentucky, USA.

Address correspondence to: Dr. D. Buggy, Department of Anesthesia, Critical Care and Pain Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. Phone: +35 3-1-803-2281; Fax: +35 3-1-803-9563; E-mail: donal.buggy{at}nbsp.ie

Purpose: Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ß protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery.

Methods: Patients (n = 30, mean age 73, range 65–86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100ß protein and Neuron-Specific Enolase levels were also documented.

Results: POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100ß protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values.

Conclusion: The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100ß protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.

This article has been cited by other articles:

				G. L. Ackland, J. Harrington, P. Downie, J. W. Holding, D. Singh-Ranger, K. Griva, M. G. Mythen, and S. P. Newman Dehydration Induced by Bowel Preparation in Older Adults Does Not Result in Cognitive Dysfunction Anesth. Analg., March 1, 2008; 106(3): 924 - 929. [Abstract] [Full Text] [PDF]

				Y. Wang, L. P. Sands, L. Vaurio, E. A. Mullen, and J. M. Leung The Effects of Postoperative Pain and Its Management on Postoperative Cognitive Dysfunction Am J Geriatr Psychiatry, January 1, 2007; 15(1): 50 - 59. [Abstract] [Full Text] [PDF]

				H. K. Fong, L. P. Sands, and J. M. Leung The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth. Analg., April 1, 2006; 102(4): 1255 - 1266. [Abstract] [Full Text] [PDF]