BACKGROUND: Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society.
METHODS: A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery.
RESULTS: Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively).
CONCLUSIONS: Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results.

UNASSIGNED: Following aneurysmal subarachnoid hemorrhage, 40-50% of survivors experience cognitive dysfunction, which affects their quality of life. Anesthetic agents play a pivotal role in aneurysm surgeries. However, substantial evidence regarding their effects on neurocognitive function is lacking. This study evaluated the effects of propofol and desflurane on postoperative neurocognitive function and serum S-100B levels.
UNASSIGNED: One hundred patients were equally randomized to receive either propofol (Group P) or desflurane (Group D). Cognitive function was assessed using the Montreal Cognitive Assessment scale at three different time points: Preoperatively, at the time of discharge, and one month after surgery. Perioperative serum levels of S-100B were also measured.
UNASSIGNED: The preoperative mean cognitive score in Group P was 21.64 + 4.46 and in Group D was 21.66 + 4.07 (P = 0.79). At discharge, a significant decrease in cognitive scores was observed compared to preoperative scores (Group P- 20.91 + 3.94, P = 0.03 and Group D-19.28 + 4.22, P = 0.00); however, scores were comparable between the two groups (P = 0.09). One month following surgery, mean cognitive scores were 22.63 + 3.57 in Group P and 20.74 + 3.89 in Group D, and the difference was significant (P = 0.04). Higher memory and orientation scores were observed in Group P than in Group D at one month (P < 0.05) in the subgroup analysis. Both groups had similar serum S-100B levels.
UNASSIGNED: The mean cognitive scores one month after surgery improved significantly with propofol compared with desflurane, but without clinical significance. Individual domain analysis demonstrated that orientation and memory scores were better preserved with propofol.

UNASSIGNED: Controlled hypotension technique was usually used to reduce intraoperative bleeding, and it could improve visualization of the surgical field during total knee arthroplasty (TKA). However, inappropriate controlled hypotension, through reducing cerebral blood flow or cerebral perfusion pressure, may cause postoperative cognitive dysfunction (POCD), so it is important to identify the appropriate level of controlled hypotension. Objective: To investigate the effects of different levels of controlled hypotension on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing TKA.
UNASSIGNED: Patients meeting inclusion criteria were enrolled through preoperative visits and basic information was obtained. The patients were randomly divided into three groups: Group A, MAP was maintained at 90-100% of the baseline; Group B, MAP was maintained at 80-90% of the baseline; Group C, MAP was maintained at 70-80% of the baseline. The MAP, HR, and rSO2 were observed and recorded during the operation. The C-reactive protein (CRP), hemoglobin (Hb) and MMSE score at 1, 3, and 7 days after operation were recorded. SPSS25.0 was used for data analysis.
UNASSIGNED: When the MAP had a decrease among the three groups, rSO2 did not decrease significantly, and none of the patients experienced POCD which was measured by MMSE. And there was no correlation between the decline in rSO2 and that in MAP.
UNASSIGNED: No POCD was experienced in the three groups, and we recommend that the controlled hypotensive target indicated by MAP was maintained at 70-80% of the baseline which not only decreases intraoperative bleeding and improve the quality of the surgical field, but also is still within safe levels.

OBJECTIVE: To investigate the influence of nerve block combined with general anesthesia on the cognitive function and postoperative pain of patients undergoing knee joint replacement and analyze the risk factors of postoperative cognitive dysfunction.
METHODS: A retrospective analysis was conducted on 104 elderly patients undergoing knee joint replacement in our hospital between January 2018 and January 2021. The control group (n=50) received laryngeal mask anesthesia, while the observation group (n=54) received ultrasound-guided nerve block combined with laryngeal mask anesthesia. The visual analogue scale (VAS) was adopted for scoring the pain intensity of both groups, and the Mini-Mental State Examination (MMSE) was used for evaluating changes in cognitive function before and after operation. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were adopted for scoring patientsbefore and after operation. Additionally, the time to spontaneous breathing recovery, time to wake up, time to open eyes when ordered, and extubation time of the two groups were recorded. The changes in serum IL-6, cortisol (Cor), and IL-10 before and after operation were compared. The two groups were compared in the dosage of used analgesic drugs, the first getting out-of-bed time, treatment expense, and hospitalization time. The correlation between VAS score and IL-6, Cor and IL-10 before and after treatment was analyzed. The adverse reactions of the two groups were also compared. Logistic regression was used to analyze risk factors for cognitive dysfunction.
RESULTS: After operation, the observation group experienced shorter spontaneous breathing recovery time, time to wake up, time to open eyes when ordered, and extubation time, than the control group (P<0.05). The observation group also consumed less sufentanil than the control group (P<0.05). Additionally, the observation group had lower VAS and MMSE scores than the control group at 6 and 12 h after operation (P>0.05) and lower SAS and SDS scores than the control group (P<0.05). Moreover, at 6 h after operation, the control group showed higher levels of IL-6, Cor and IL-10 than the observation group (P<0.05), and the control group experienced later first getting out-of-bed time and a longer hospitalization time than the observation group (P<0.05). There was a positive correlation between VAS score and IL-6 as well as Cor before and after treatment (P<0.05). The two groups were similar in treatment expense (P>0.05) and the incidence of adverse reactions (P>0.05). Age and anesthesia scheme were risk factors for postoperative cognitive dysfunction.
CONCLUSIONS: Nerve block combined with general anesthesia can effectively improve the cognitive function and analgesic effect of elderly patients undergoing knee joint replacement, and accelerate recovery time, without increasing f adverse reactions, and can also accelerate recovery of their cognitive function.

UNASSIGNED: During cardiosurgical procedures that use extracorporeal circulation (ECC), a variety of neurological complications can occur, and postoperative cognitive deficits remain an unsolved problem. Among the sources of these complications are intraoperatively detectable cerebral microemboli, which mainly consist of air. This study\'s purpose was to assess neuroprotective effects of reducing these gaseous microemboli using a dynamic bubble trap (DBT) in patients undergoing pulmonary endarterectomy (PEA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).
UNASSIGNED: Patients undergoing PEA were randomly assigned to receive either a DBT (n=47) or no additional device (controls, n=46) during ECC. Neuropsychological testing was performed before and 3 months after PEA. The primary endpoint was cognitive improvement in the DBT group (n=29) compared with the control group (n=42). As secondary endpoint, ischemic brain micro-lesions were analyzed on postoperative days 6 through 10 using diffusion-weighted magnetic resonance imaging (MRI).
UNASSIGNED: Analysis of interaction effects revealed improved performance in visual long-term memory (P=0.008, η2=0.099), verbal long-term memory (P=0.030, η2=0.067), verbal short-term memory (P=0.014, η2=0.083), and attention and processing speed (P=0.043, η2=0.056) from pre- to post-testing in the DBT group compared to control group. In MRI, postoperative ischemic micro-lesions could only be detected in one patient; another patient suffered a severe bihemispheric embolic stroke.
UNASSIGNED: DBT positively influences memory function after PEA. This effect is most likely caused by the reduction of gaseous microemboli.
UNASSIGNED: This study is registered in the German Clinical Trials Register, ID: DRKS00021499.

OBJECTIVE: The purpose of this study was to examine the effects of various depths of anesthesia monitored using Narcotrend on cognitive function in elderly patients after video-assisted thoracic surgery (VATS) lobectomy.
METHODS: A total of 73 elderly patients who underwent VATS lobectomy were selected and divided into a control group (n=36) and an observation group (n=37) using a random number table. Both groups received general anesthesia. The Narcotrend index (NTI) of the control group was maintained at 50-59 and that of the observation group was maintained at 30-39.
RESULTS: The heart period (HP) and mean arterial pressure (MAP) from both groups were decreased first, and then were increased during T1-T5; the MAP levels at T2, T3 , and T4 were lower in the observation group than in the control group (P < 0.05). The propofol dosage was higher and the awake to extubation time was greater in the observation group than in the control group (P < 0.05). The visual analogue scale (VAS) score was lower in the observation group than in the control group at 6 h and 12 h after surgery (P < 0.05). The left and right regional cerebral oxygen saturation (rSO2) at T3 -T4 was higher in the observation group and the cerebral oxygen extraction ratio (CERO2) was lower in the observation group than in the control group (P < 0.05).
CONCLUSIONS: The anesthetic depth that maintained an NTI of 30-39 as monitored using Narcotrend could improve cerebral oxygen metabolism, inhibit the inflammatory reaction, and reduce the incidence of postoperative cognitive dysfunction (POCD) in patients after VATS lobectomy.

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting were investigated. Eighty patients undergoing systemic anesthesia with extracorporeal coronary artery bypass grafting in The People\'s Hospital of Guangxi Zhuang Autonomous Region from January 2015 to August 2017 were selected and randomly divided into the observation group (n=40) and control group (n=40). The two groups were treated with dexmedetomidine and equal volume of normal saline, respectively. Moreover, safety indexes including EEG bispectral index (BIS) at 30 min before induction of anesthesia (T0), immediately after intubation (T1), when incision was made (T2), when chest was closed (T3), when operation was completed (T4) and at 6 h after operation (T5), intraoperative circulatory system-related complications, cortisol, epinephrine and norepinephrine levels at the end of surgery as well as anesthesia recovery time and postoperative mechanical ventilation time were recorded and compared. All the patients were followed up for 1 week. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were administered at 1, 3 and 7 days after operation, and the incidence of intraoperative awareness and postoperative cognitive dysfunction was recorded. BIS value in the observation group was lower than that in the control group (P<0.05) at T1-T4 time points, and the BIS value in the observation group was higher than that in the control group (P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension and hypotension in the observation group was significantly lower than those in the control group (P<0.05). At the end of operation, levels of cortisol, epinephrine and norepinephrine in the observation group were significantly lower than those in the control group (P<0.05). Anesthesia recovery time and postoperative mechanical ventilation time in the observation group was significantly shorter than the time in the control group (P<0.05). MMSE and MoCA scores of the observation group were better than those of the control group (P<0.05). The incidence of cognitive impairment and postoperative cognitive impairment in the observation group was significantly lower than those in the control group (P<0.05). Therefore, it is concluded that dexmedetomidine can effectively reduce the incidence of postoperative cognitive impairment in patients undergoing coronary artery bypass grafting, and it is of high safety for circulatory function.

Objective: To analyze the effect of preoperative depression on early postoperative cognitive function after general anesthesia during laparoscopic colon cancer surgery. Methods: One hundred and fifty ASA Ⅰ-Ⅱ general aneasthesia patients (male70, female 80)from Sir Run Run Shaw Hospital in May of 2015 to April of 2016, aged 50-85, undergoing selective laparoscopic colon cancer patients were included. Evaluated preoperative depression by self-rating depression scale and evaluated postoperative cognitive function on 1, 3, 7 days by post-operative quality recovery scale. Use the multi-factor logistic regression to select the risk factors. Results: There were 115 (76.7%) patients occurred poor cognitive function. According to SDS, The results of logistic regression analysis showed that the risk factors for postoperative poor cognitive function was severe depression(OR 1.295, 95% CI 1.012-13.184, P=0.048). Conclusion: Preoperative severe depression is a risk factor on postoperative cognitive function in laparoscopic colon cancer patients during general anesthesia.
目的： 探究术前抑郁对全麻腹腔镜结肠癌患者术后早期认知功能恢复的影响。 方法： 选择2015年5月至2016年4月在浙江大学医学院附属邵逸夫医院住院并择期行全麻下腹腔镜结肠癌根治术患者150例，男70例，女80例，年龄50～85岁，ASA Ⅰ～Ⅱ级。评估术前抑郁状态[抑郁自评量表(SDS)]和术后认知功能1 d、3 d和7 d恢复情况[评估量表(PQRS)]，用Logistic回归分析术后认知恢复不良的危险因素。 结果： 共115例(76.7%)发生术后认知功能恢复不良。重度抑郁增加术后认知恢复不良风险(OR 1.295, 95% CI 1.012～13.184, P＝0.048)。 结论： 术前重度抑郁是增加术后认知功能恢复不良的独立危险因素。.

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.

This study analyzed the preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients by observing the perioperative kinetics of inflammatory cytokines, cortisol and melatonin.A total of 149 elderly oral cancer patients who had undergone tumor resection surgery were selected and randomly divided into 2 groups, Group D and Group S. After surgery, Group D was assigned to take intravenous dexmedetomidine at a dose of 0.2 μg/kg/h for 12 h, while Group S was administered physiological saline in the same manner. On the day of surgery and for the first three postoperative days, the patients were assessed with the Mini-Mental State Examination (MMSE) and a 40-item quality of recovery score questionnaire (QoR40) at 7:00 am every morning. Venous blood was harvested at the same time. Then, IL-6, CRP, cortisol and melatonin levels were measured. There were no significant between-group differences in the baseline characteristics. After surgery, the MMSE and QoR40 scores in Group D were better than those in Group S. No between-group differences were observed in the incidences of severe hypotension and bradycardia. Moreover, respiratory depression was not observed in the 2 groups. The peaks of IL-6, CRP and cortisol concentrations in Group D were lower than those in Group S. However, the melatonin levels did not differ between the 2 groups. In elderly patients, intravenous dexmedetomidine administered postoperatively for 12 h at a dose of 0.2 ug/kg/h could improve postoperative cognitive function and recovery quality by decreasing excessive inflammation and stress levels.