Dynamics of cognitive functions in the early postoperative period after spinal neurosurgical operations

A.V. Solenkova, A.A. Poddubskaya, A.Yu.Lubnin, D.A. Moshchev, N.A. Dzyubanova

“National Medical Research Center of Neurosurgery” named after N.N. Burdenko Ministry of Health of Russian Federation, Moscow

For correspondence: Lubnin Andrei Yurevich — MD, Professor, head of Department of anaesthesiology and intensive care unit “National Medical Research Center of Neurosurgery” named after Ac. N.N. Burdenko Ministry of Health of Russian Federation, Moscow; e-mail: lubnin@nsi.ru

For citation: Solenkova AV, Poddubskaya AA, Lubnin AYu, et al. Dynamics of Cognitive Functions in the Early Postoperative Period after Spinal Neurosurgical Operations. Alexander Saltanov Intensive Care Herald. 2018;1:27–36.

DOI: 10.21320/1818-474X-2018-1-27-36


The aim of the study was to study cognitive changes in the early postoperative period after spinal neurosurgical operations. Material and methods. 80 patients were operated with spinal pathology. The patients were divided into two groups: the 1st group consisted of 40 patients under the age of 60 (mean age 42 ± 11.6), the second group consisted of 40 patients aged 60 years and older (mean age was 68 ± 9.77). Various methods of anesthesia were used in the work. Neuropsychological examination in accordance with the general clinical protocol before the operation and 5–7 days after the operation. The following factors for evaluation were chosen: duration of anesthesia, hemodynamics, anesthesia method and type of anesthetic, monitoring of the depth of anesthesia using BIS technology. Results. Patients ≥ 60 years before the operation had cognitive changes in working memory and regulatory functions aggravated in the postoperative period. With short anesthesia (< 200 minutes), significant differences in test results before and after surgery were not obtained. Prolonged anesthesia (≥ 200 minutes) has negative effects on cognitive functions based on the results of the working memory test and MOCA. A greater decrease in neurodynamic parameters and MOCA scores is observed with the intravenous propofol anesthesia compared with an inhaled anesthesia with sevoflurane.

Keywords: cognitive functions, spinal pathology, spinal operations, postoperative cognitive dysfunction

Received: 20.12.2017


References

  1. Gatchel R.J., Polatin P.B., Mayer T.G. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine. 1995; 20: 2702–2709.
  2. Schnurr R.F., MacDonald M.R. Memory complaints in chronic pain. Clin. J. Pain. 1995; 11(2): 103–111.
  3. Karp J.F., Reynolds C.F., Butter M.A., et al. The relationship between pain and mental flexibility in older adult pain clinic patients. Pain. Med. 2006; 7(5): 444–452. doi: 10.1111/j.1526-4637.2006.00212.x.
  4. Moriarty O., McGuire B.E., Finn D.P., et al. The effect of pain on cognitive function: A review of clinical and preclinical research. Progress in Neurobiology. 2011; 93: 385–404. DOI: 10.1016/j.pneurobio.2011.01.002.
  5. Berryman C., Stanton T.R., Bowering K.J., et al. Evidence for working memory deficits in chronic pain: A systematic review and meta-analysis. PAIN. 2013; 154: 1181–1196. doi: 10.1016/j.pain.2013.03.002.
  6. Canet J., Raeder J., Rasmussen L.S., et al. (ISPOCD2 investigators).Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol. Scand. 2003; 47(10): 1204–1210.
  7. Newman S., Stygall J., Hirani S., et al. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology. 2007; 106: 572–590.
  8. Johnson T., Monk T.G., Rasmussen L.S., et al. Postoperative Cognitive Dysfunction in Middle-aged Patients. Anesthesiology. 2002; 96: 1351–1357.
  9. Stump D.A., Brown W.R., Moody D.M., et al. Microemboli and neurologic dysfunction after cardiovascular surgery. Cardiothorac. Vasc. Anesth. 1999; 3: 47–54.
  10. Monk T.G., Weldon B C., Garvan C.W., et al. Predictors of Cognitive Dysfunction after Major Noncardiac Surgery. Anesthesiology. 2008; 108: 18–30.
  11. Moller J.T., Cluitmans P., Rasmussen L.S., et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet. 1998; 351: 857–861.
  12. Rasmussen L.S., Larsen K., Houx P., et al. The assessment of postoperative cognitive function. Acta Anaesthesiol. Scand. 2001; 45(3): 275–289.
  13. Соленкова А.В., Бондаренко А.А., Дзюбанова Н.А., Лубнин А.Ю. Оценка состояния когнитивных функций при операциях на позвоночнике и спинном мозге. Анестезиология и реаниматология. 2012; 4: 38–41. [Solenkova A.V., Bondarenko A.A., Dzyubanova N.A., Lubnin A.Y. Cognitive status assessment after spinal surgery. Anesthesiology and resuscitation. 2012; 4: 38–41. (In Russ)]
  14. Fritz H.C., McAuley J.H., Wittfeld K., et al. Chronic Back Pain Is Associated With Decreased Prefrontal and Anterior Insular Gray Matter: Results From a Population-Based Cohort Study. J. Pain. 2016; 17(1): 111–118. doi: 10.1016/j.jpain.2015.10.003.
  15. БорисовК.Ю., Шайбакова В.Л., Чепраков Р.А.  и др. Кардио- и нейропротекция ингаляционными анестетиками в кардиохирургии. Патология кровообращения и кардиохирургия. 2014; 3: 5–11. [Borisov K.Y., Shaybakova V.L., Cherpakov R.A., et al. Cardio- and neuroprotection of inhaled anesthetics in cardiac surgery. Pathology of circulation and heart surgery. 2014; 3: 5–11. (In Russ)]
  16. ЛарионовМ.В., Трубникова О.А., Плотников Г.П. и др. Обоснование выбора анестетиков с целью защиты головного мозга и профилактики когнитивного снижения во время операции коронарного шунтирования. Медицина в Кузбассе. 2015; 14(3): 43–51. [Larionov M.V., Trubnikova O.A., Plotnikov G.P, et al. Rationale for anesthetics choice to protect the brain and prevent cognitive dysfunction during coronary artery bypass surgery. Medicine in the Kuzbass. 2015; 14(3): 43–51. (In Russ)]
  17. Wang H., Lu S., Yu Q., Liang W., et al. Sevoflurane preconditioning confers neuroprotection via anti-inflammatory effects. Front. Biosci. 2011; 3: 604–615.
  18. Shan J., Sun L., Wang В.,et al. Comparison of the neuroprotective effects and recovery profiles of isoflurane, sevoflurane and desflurane as neurosurgical pre-conditioning on ischemia/reperfusion cerebral injury. Int. J. Exp. Pathol. 2015; 8: 2001–2009.
  19. Hu X., Zhang Y., Li W., Liu J., Li Y. Preconditioning with sevoflurane ameliorates spatial learning and memory deficit after focal cerebral ischemia-reperfusion in rats. Int. J. Dev. Neurosci. 2013; 31: 328–333. doi:10.1016/j.ijdevneu.2013.04.004.