Tags

Type your tag names separated by a space and hit enter

Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients.
Anesth Analg. 2014 Oct; 119(4):947-955.A&A

Abstract

BACKGROUND

Cerebral cholinergic transmission plays a key role in cognitive function, and anticholinergic drugs administered during the perioperative phase are a hypothetical cause of postoperative cognitive dysfunction (POCD). We hypothesized that a perioperative increase in serum anticholinergic activity (SAA) is associated with POCD in elderly patients.

METHODS

Seventy-nine patients aged >65 years undergoing elective major surgery under standardized general anesthesia (thiopental, sevoflurane, fentanyl, and atracurium) were investigated. Cognitive functions were assessed preoperatively and 7 days postoperatively using the extended version of the CERAD-Neuropsychological Assessment Battery. POCD was defined as a postoperative decline >1 z-score in at least 2 test variables. SAA was measured preoperatively and 7 days postoperatively at the time of cognitive testing. Hodges-Lehmann median differences and their 95% confidence intervals were calculated for between-group comparisons.

RESULTS

Of the patients who completed the study, 46% developed POCD. Patients with POCD were slightly older and less educated than patients without POCD. There were no relevant differences between patients with and without POCD regarding gender, demographically corrected baseline cognitive functions, and duration of anesthesia. There were no large differences between patients with and without POCD regarding SAA preoperatively (pmol/mL, median [interquartile range]/median difference [95% CI], P; 1.14 [0.72, 2.37] vs 1.13 [0.68, 1.68]/0.12 [-0.31, 0.57], P = 0.56), SAA 7 days postoperatively (1.32 [0.68, 2.59] vs 0.97 [0.65, 1.83]/0.25 [-0.26, 0.81], P = 0.37), or changes in SAA (0.08 [-0.50, 0.70] vs -0.02 [-0.53, 0.41]/0.1 [-0.31, 0.52], P = 0.62). There was no significant relationship between changes in SAA and changes in cognitive function (Spearman rank correlation coefficient preoperatively of 0.03 [95% CI, -0.21, 0.26] and postoperatively of -0.002 [95% CI, -0.24, 0.23]).

CONCLUSIONS

In this panel of patients with low baseline SAA and clinically insignificant perioperative anticholinergic burden, although a relationship cannot be excluded in some patients, our analysis suggests that POCD is probably not a substantial consequence of anticholinergic medications administered perioperatively but rather due to other mechanisms.

Authors+Show Affiliations

From the Department of Anesthesia, Lausanne University Hospital, Lausanne, Switzerland; Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; and Memory Clinic, University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25089730

Citation

Rossi, Ariane, et al. "Serum Anticholinergic Activity and Postoperative Cognitive Dysfunction in Elderly Patients." Anesthesia and Analgesia, vol. 119, no. 4, 2014, pp. 947-955.
Rossi A, Burkhart C, Dell-Kuster S, et al. Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients. Anesth Analg. 2014;119(4):947-955.
Rossi, A., Burkhart, C., Dell-Kuster, S., Pollock, B. G., Strebel, S. P., Monsch, A. U., Kern, C., & Steiner, L. A. (2014). Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients. Anesthesia and Analgesia, 119(4), 947-955. https://doi.org/10.1213/ANE.0000000000000390
Rossi A, et al. Serum Anticholinergic Activity and Postoperative Cognitive Dysfunction in Elderly Patients. Anesth Analg. 2014;119(4):947-955. PubMed PMID: 25089730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients. AU - Rossi,Ariane, AU - Burkhart,Christoph, AU - Dell-Kuster,Salome, AU - Pollock,Bruce G, AU - Strebel,Stephan P, AU - Monsch,Andreas U, AU - Kern,Christian, AU - Steiner,Luzius A, PY - 2014/8/5/entrez PY - 2014/8/5/pubmed PY - 2014/12/15/medline SP - 947 EP - 955 JF - Anesthesia and analgesia JO - Anesth Analg VL - 119 IS - 4 N2 - BACKGROUND: Cerebral cholinergic transmission plays a key role in cognitive function, and anticholinergic drugs administered during the perioperative phase are a hypothetical cause of postoperative cognitive dysfunction (POCD). We hypothesized that a perioperative increase in serum anticholinergic activity (SAA) is associated with POCD in elderly patients. METHODS: Seventy-nine patients aged >65 years undergoing elective major surgery under standardized general anesthesia (thiopental, sevoflurane, fentanyl, and atracurium) were investigated. Cognitive functions were assessed preoperatively and 7 days postoperatively using the extended version of the CERAD-Neuropsychological Assessment Battery. POCD was defined as a postoperative decline >1 z-score in at least 2 test variables. SAA was measured preoperatively and 7 days postoperatively at the time of cognitive testing. Hodges-Lehmann median differences and their 95% confidence intervals were calculated for between-group comparisons. RESULTS: Of the patients who completed the study, 46% developed POCD. Patients with POCD were slightly older and less educated than patients without POCD. There were no relevant differences between patients with and without POCD regarding gender, demographically corrected baseline cognitive functions, and duration of anesthesia. There were no large differences between patients with and without POCD regarding SAA preoperatively (pmol/mL, median [interquartile range]/median difference [95% CI], P; 1.14 [0.72, 2.37] vs 1.13 [0.68, 1.68]/0.12 [-0.31, 0.57], P = 0.56), SAA 7 days postoperatively (1.32 [0.68, 2.59] vs 0.97 [0.65, 1.83]/0.25 [-0.26, 0.81], P = 0.37), or changes in SAA (0.08 [-0.50, 0.70] vs -0.02 [-0.53, 0.41]/0.1 [-0.31, 0.52], P = 0.62). There was no significant relationship between changes in SAA and changes in cognitive function (Spearman rank correlation coefficient preoperatively of 0.03 [95% CI, -0.21, 0.26] and postoperatively of -0.002 [95% CI, -0.24, 0.23]). CONCLUSIONS: In this panel of patients with low baseline SAA and clinically insignificant perioperative anticholinergic burden, although a relationship cannot be excluded in some patients, our analysis suggests that POCD is probably not a substantial consequence of anticholinergic medications administered perioperatively but rather due to other mechanisms. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/25089730/Serum_anticholinergic_activity_and_postoperative_cognitive_dysfunction_in_elderly_patients_ L2 - https://doi.org/10.1213/ANE.0000000000000390 DB - PRIME DP - Unbound Medicine ER -