Daily Anesthesiology Research Analysis

BACKGROUND: We previously have shown that low intraoperative EEG alpha power is associated with impaired preoperative cognition, a delirium risk factor, and that intraoperative anaesthetic-dose-adjusted EEG bispectral index values were associated with a four-fold increased risk of postoperative delirium (POD). Yet, associations between intraoperative anaesthetic-dose-adjusted alpha power and delirium or delirium risk factors have yet to be quantified. METHODS: We examined cerebrospinal fluid (CSF) Alzheimer's disease (AD)-related biomarkers, cognitive scores, EEG recordings, and delirium data from 82 noncardiac, non-neurologic surgical patients ≥60 yr in age. Based on prior work, each participant's intraoperative frontoparietal EEG alpha power was anaesthetic dose-adjusted by dividing it by (2.5 minus the age-adjusted end-tidal minimum alveolar concentration), and then analysed for its association with POD and delirium risk factors, preoperative CSF AD-related biomarkers, and preoperative cognition. RESULTS: Lower anaesthetic-dose-adjusted frontoparietal alpha power was associated with increased odds of POD (odds ratio [95% confidence interval (CI)]: 1.44 [1.09, 1.89], P=0.009) and moderate-to-severe delirium (odds ratio [95% CI]: 1.44 [1.04, 2.00], P=0.030). Anaesthetic-dose-adjusted frontoparietal alpha power was not associated with pathologic concentrations of CSF pTau-181, Aβ1-42, or pTau-181/Aβ1-42 (P>0.05). In multivariable cognitive models, anaesthetic-dose-adjusted frontoparietal alpha power was associated with preoperative timed processing speed/executive function performance (β [95% CI]: 0.27 [0.06, 0.49], P=0.014), but not with untimed attention/memory performance (β [95% CI]: 0.12 [-0.13, 0.37], P=0.349). CONCLUSIONS: Lower intraoperative anaesthetic-dose-adjusted frontoparietal alpha power was associated with delirium and delirium-predisposing factors (impaired preoperative processing speed/executive function in timed attention tasks). Larger studies are warranted to confirm these associations after further adjustment for covariates.

BACKGROUND: Postoperative sore throat (POST) is a minor complication of general anesthesia with tracheal intubation but may negatively affect patient satisfaction and postoperative recovery. The shape of the endotracheal tube (ETT) cuff may influence the incidence and severity of POST. METHODS: This prospective, randomized, double-blinded study was conducted on 174 female patients with breast cancer. They were randomized into the cylindrical (CYL) (group C) and tapered (TAP) (group T) cuff ETT groups. Data on patient demographics, surgical characteristics, and factors related to tracheal intubation were collected. Furthermore, the incidence and severity of POST at the selected time points were duly recorded for analysis. Other adverse events and anesthesia satisfaction were also documented. RESULTS: During the 48-h evaluation period, group T exhibited reduced overall incidence of POST compared with group C. The incidence and severity of POST at 1, 6, 12, 24, and 48 h postoperatively were also significantly lower in group T than in group C. No significant difference in subglottic airway injury was observed between the two groups. Postoperative anesthesia satisfaction was higher in group T. CONCLUSIONS: The present study demonstrates that the utilization of a TAP cuff ETT rather than a CYL cuff ETT in patients undergoing breast cancer surgery reduced the incidence and severity of POST. The selection of an appropriate ETT for surgical patients could play a pivotal role in alleviating airway complications, enhancing postoperative recovery, and improving anesthesia satisfaction. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT06505850) on 2024-07-17.

BACKGROUND: Perioperative neurocognitive disorders encompass delayed neurocognitive recovery (dNCR). Emerging evidence suggests that chemokines play a crucial role in the pathogenesis of various cognitive impairment diseases. However, the association between chemokines and dNCR remains unclear. Therefore, we aimed to investigate the relationship between serum chemokine levels and dNCR in elderly patients undergoing non-cardiac surgery. METHODS: A total of 144 patients undergoing elective major non-cardiac surgery were accessed in neuropsychological testing 1 day prior to and 1 week following the surgery. Blood samples were collected before the initiation of anesthesia and one hour following the cessation of anesthesia. We employed a retrospective nested case-control study design, utilizing one control per dNCR case. Matching criteria included age (± 5 years), duration of surgery (± 90 min), and baseline MMSE score (± 3). We compared the serum levels of CCL2, CCL5, CCL11, and CXCL8 between the matched dNCR and non-dNCR groups. RESULTS: dNCR was observed in 31.25% (45 of 144) of the patients seven days post-surgery, resulting in a final matched sample size of 21 pairs. In the preoperative comparison, the serum concentration of CCL11 was significantly higher in the matched dNCR group compared to the matched non-dNCR group (P= 0.039). In the postoperative comparison, the CCL5 concentration was significantly lower in the dNCR than in the non-dNCR group (P= 0.030). When comparing the differences between postoperative and preoperative levels, the absolute change in CCL11 was significantly greater in the dNCR group compared to the non-dNCR group (P= 0.046). Additionally, the postoperative-to-preoperative ratios of CCL5 and CCL11 in the dNCR group were both significantly lower than those in the non-dNCR group (P= 0.046, P= 0.005). There were no significant differences in CCL2 or CXCL8 levels between the two matched groups. CONCLUSIONS: Serum levels of CCL 5 and CCL 11 significantly decreased in elderly patients with dNCR following non-cardiac surgery, which may contribute to the identification of patients at high risk for dNCR. TRIAL REGISTRATION: This study was registered on chictr.org.cn (ChiCTR1800014473, 16/01/2018).