Impact of Anaesthesia on Postoperative Cognitive Dysfunction in the Elderly Population: A Myth or Reality
Background: With the increasing number of surgeries being performed on elderly people worldwide each year, it has become important to study and manage the complications related to them. Post-operative cognitive dysfunction (POCD) is an age-related complication, very frequent in the older people. Hence, the present study was undertaken to detect the incidence of POCD and compare it between those undergoing surgery under regional anaesthesia and general anaesthesia.
Methods: This prospective observational study was conducted in 81 patients of age above 60 years, ASA physical status I, II, III, undergoing major surgeries during the period of one year. Pre and post-operative cognitive assessment was done using the Mini Mental State Examination (MMSE)/ Short Portable Mental State Questionnaire (SPMSQ), and Memory Impairment Screen (MIS).
Results: About 40% of the study population showed POCD. There was no significant difference between General and Regional anaesthesia techniques regarding POCD incidence. Increasing age and extensive surgery correlated with higher POCD occurrence. No significant association was found between addiction, co-morbidities and type of surgery.
Conclusion: Increasing age makes the elderly more prone to POCD and can have significant effect on their quality of life. So, such cases must be looked for in this population and managed accordingly.
Monk TG, Weldon BC, Garvan CW, et al. Predictors of Cognitive Dysfunction after Major Noncardiac Surgery. Anesthesiology. 2008;108(1):18-30.
Berger M, Nadler JW, Browndyke J, et al. Postoperative Cognitive Dysfunction. Anesthesiol Clin. 2015;33(3):517-550.
Caza N, Taha R, Qi Y, Blaise G. The effects of surgery and anesthesia on memory and cognition. Prog Brain Res. 2008;169:409-422.
Tsai TL, Sands LP, Leung JM. An Update on Postoperative Cognitive Dysfunction. Adv Anesth. 2010; 28(1): 269-284.
Skvarc DR, Berk M, Byrne LK, et al. Post-Operative Cognitive Dysfunction: An exploration of the inflammatory hypothesis and novel therapies. Neurosci Biobehav Rev. 2018;84:116-133.
Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand. 2010; 54(8): 951-956.
Mandal S, Basu M, Kirtania J, et al. Impact of general versus epidural anesthesia on early post-operative cognitive dysfunction following hip and knee surgery. J Emerg Trauma Shock. 2011; 4(1):23-28.
Malhotra C, Chan A, Matchar D, Seow D, Chuo A, Do YK. Diagnostic performance of short portable mental status questionnaire for screening dementia among patients attending cognitive assessment clinics in Singapore. Ann Acad Med Singapore. 2013; 42(7): 315-319.
Telugu Seetharam D, Srisha V, Sunilkumar K, et al. Postoperative cognitive functions after general anaesthesia with Sevoflurane and Desflurane in south Asian elderly. M.E.J. Anesth. 2013; 22(2):143-148.
Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119-125.
Rasmussen LS. Postoperative cognitive dysfunction: incidence and prevention. Best Pract Res Clin Anaesthesiol. 2006; 20(2):315-330.
Somprakit P, Lertakyamanee J, Satraratanamai C, et al. Mental state change after general and regional anesthesia in adults and elderly patients, a randomized clinical trial. J Med Assoc Thai. 2002; 85 Suppl 3: S875-S883.
Kotekar N, Kuruvilla CS, Murthy V. Post-operative cognitive dysfunction in the elderly: A prospective clinical study. Indian J Anaesth. 2014;58(3):263-268. doi:10.4103/0019-5049.135034.
Dijkstra JB, Houx PJ, Jolles J. Cognition after major surgery in the elderly: test performance and complaints. Br J Anaesth. 1999;82(6):867-874.
Rasmussen LS, Johnson T, Kuipers HM, et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003; 47(3):260-266.
Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975; 23(10): 433-441.
Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet (London, England). 1998; 351(9106): 857-861.
Hudetz JA, Iqbal Z, Gandhi SD, et al. Postoperative cognitive dysfunction in older patients with a history of alcohol abuse. Anesthesiology. 2007;106(3): 423-430.
Ward B, Imarengiaye C, Peirovy J, Chung F. Cognitive function is minimally impaired after ambulatory surgery. Can J Anesth Can d’anesthesie. 2005; 52(10): 1017-1021.
Canet J, Raeder J, Rasmussen LS, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand. 2003;47(10):1204-1210.
Copyright (c) 2019 International Journal of Biomedical Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- An author must submit Copyright form After acceptance of the article.