-
BMC Anesthesiology Dec 2019The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery... (Review)
Review
BACKGROUND
The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.
MAIN BODY
This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment.
CONCLUSIONS
Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.
Topics: Anesthesia, General; Anesthesiology; Cognitive Dysfunction; Humans; Postoperative Cognitive Complications; Risk Factors
PubMed: 31881996
DOI: 10.1186/s12871-019-0903-7 -
Journal of Anesthesia Oct 2020As the recent update of General anaesthesia compared to spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human... (Review)
Review
As the recent update of General anaesthesia compared to spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children's brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.
Topics: Anesthesia, General; Anesthesia, Spinal; Anesthetics; Animals; Brain; Child; Child, Preschool; Humans; Neurotoxicity Syndromes
PubMed: 32601887
DOI: 10.1007/s00540-020-02812-9 -
BMC Anesthesiology Aug 2022Ciprofol is a recently developed, short-acting γ-aminobutyric acid receptor agonist sedative that is more potent than propofol, but there have been few clinical... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Ciprofol is a recently developed, short-acting γ-aminobutyric acid receptor agonist sedative that is more potent than propofol, but there have been few clinical studies of this agent to date. Here, we sought to examine the safety and efficacy of ciprofol use for the induction of general anesthesia in individuals undergoing gynecological surgery.
METHODS
Women between the ages of 18 and 60 years (ASA physical status 1 or 2) who were scheduled to undergo elective gynecological surgery under general anesthesia were randomly assigned to two equally sized groups in which anesthesia induction was performed using either ciprofol or propofol. General anesthesia induction success rates were the primary outcome for this study, while secondary outcomes included changes in BIS during the 10 min following the first administration of the study drug, the duration of successful induction, and adverse event incidence.
RESULTS
A total of 120 women were included in the study. A 100% rate of successful induction was achieved in both the ciprofol and propofol groups, with no significant differences between these groups with respect to the duration of successful induction (34.8 ± 15.5 s vs 35.4 ± 9.5 s, P = 0.832), the time to the disappearance of the eyelash reflex (33.7 ± 10.6 s vs 34.0 ± 6.5 s, P = 0.860), or tracheal intubation (58.2 ± 31.1 s vs 53.9 ± 25.4 s, P = 0.448). Adverse event rates, including intubation responses, were significantly lower in the ciprofol group as compared to the propofol group(20% vs 48.33%, P = 0.0019). Ciprofol was associated with reduced injection pain relative to propofol (16.7% vs 58.3%, P < 0.001).
CONCLUSIONS
Ciprofol exhibits comparable efficacy to that of propofol when used for the induction of general anesthesia in individuals undergoing gynecological surgery and is associated with fewer adverse events.
Topics: Adolescent; Adult; Anesthesia, General; Anesthetics, Intravenous; Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Propofol; Prospective Studies; Young Adult
PubMed: 35922771
DOI: 10.1186/s12871-022-01782-7 -
Minerva Anestesiologica May 2016Automated anesthesia which may offer to the physician time to control hemodynamic and to supervise neurological outcome and which may offer to the patient safety and... (Review)
Review
Automated anesthesia which may offer to the physician time to control hemodynamic and to supervise neurological outcome and which may offer to the patient safety and quality was until recently consider as a holy grail. But this field of research is now increasing in every component of general anesthesia (hypnosis, nociception, neuromuscular blockade) and literature describes some successful algorithms - single or multi closed-loop controller. The aim of these devices is to control a predefined target and to continuously titrate anesthetics whatever the patients' co morbidities and surgical events to reach this target. Literature contains many randomized trials comparing manual and automated anesthesia and shows feasibility and safety of this system. Automation could quickly concern other aspects of anesthesia as fluid management and this review proposes an overview of closed-loop systems in anesthesia.
Topics: Analgesia; Anesthesia, Closed-Circuit; Anesthesia, General; Artificial Intelligence; Automation; Electroencephalography; Ergonomics; Hemodynamics; Humans; Neuromuscular Blockade; Safety
PubMed: 26554614
DOI: No ID Found -
British Journal of Anaesthesia Apr 2021
Clinical Trial Observational Study
Opioid-free anaesthesia for anterior total hip replacement under general anaesthesia: the Observational Prospective Study of Opiate-free Anesthesia for Anterior Total Hip Replacement trial.
Topics: Aged; Analgesics, Opioid; Anesthesia, General; Arthroplasty, Replacement, Hip; Female; Humans; Male; Middle Aged; Pain, Postoperative; Prospective Studies
PubMed: 33549323
DOI: 10.1016/j.bja.2021.01.001 -
Medicina (Kaunas, Lithuania) Jul 2022In the last decades, several new and modern techniques have been developed for the continuous monitoring of vitals for patients undergoing surgery under general...
In the last decades, several new and modern techniques have been developed for the continuous monitoring of vitals for patients undergoing surgery under general anesthesia. These complex methods are meant to come as an adjunct to classical monitoring protocols used in general anesthesia to increase patient safety. The main objectives of multimodal monitoring are avoiding the over- or underdosing of anesthetic drugs, adapting the concentration for the substances in use, reducing post-anesthetic complications, and increasing patient comfort. Recent studies have shown a series of benefits with significant clinical impact such as a reduced incidence of nausea and vomiting, shorter reversal times, a reduction in opioid consumption, shorter hospital stays, and an increase in patient satisfaction.
Topics: Analgesics, Opioid; Anesthesia, General; Humans
PubMed: 35888675
DOI: 10.3390/medicina58070956 -
Anesthesiology Nov 2020
Topics: Anesthesia, General; Lung; Respiration, Artificial
PubMed: 32970099
DOI: 10.1097/ALN.0000000000003570 -
Korean Journal of Anesthesiology Dec 2022
Topics: Humans; Benzodiazepines; Anesthesia, General
PubMed: 36464845
DOI: 10.4097/kja.22692 -
British Journal of Anaesthesia Feb 2023Whilst the general presumption of the public is that general anaesthesia prevents awareness of any sensory stimuli, Lennertz and colleagues have shown in this issue of...
Whilst the general presumption of the public is that general anaesthesia prevents awareness of any sensory stimuli, Lennertz and colleagues have shown in this issue of the British Journal of Anaesthesia that 11% of young adults were able to respond to auditory commands when neuromuscular blocking drugs were prevented from reaching one arm using the isolated forearm technique. This occurred with anaesthetic regimens that followed usual clinical practice in each of the 10 countries that enrolled patients, and it was significantly more common in women than in men. This high incidence demands attention. Further characterisation of the experience of these patients is essential to our understanding of the state of general anaesthesia.
Topics: Male; Young Adult; Humans; Female; Anesthesia, General; Anesthetics; Neuromuscular Blockade; Forearm; Upper Extremity
PubMed: 36344330
DOI: 10.1016/j.bja.2022.09.010 -
Anesthesiology Jul 2021
Topics: Anesthesia, Epidural; Anesthesia, General; Humans; Neoplasms
PubMed: 33930110
DOI: 10.1097/ALN.0000000000003804