Top

Published in:

01-03-2018 | News and Views

Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications

Authors: Cristina Zarbo, Michela Brivio, Agostino Brugnera, Chiara Malandrino, Gaetano Trezzi, Massimo Rabboni, Emi Bondi, Angelo Compare, Luigi Frigerio

Published in: Archives of Gynecology and Obstetrics | Issue 3/2018

Abstract

Objective

Postoperative cognitive decline (POCD) is known to occur quite frequently after a cardiac surgery, especially in older population. Few studies specifically focused on its incidence and characteristics in gynecological setting.

Methods

Current opinions and future applications of POCD studies in gynecological setting have been discussed.

Result

There are still many questions and issues about POCD in gynecological setting that remain unanswered as well as numerous research fields that have not been still explored. In particular, from this article emerges the need of further studies in gynecological setting focusing on: (a) the evaluation of long-term effect of POCD (e.g. over 3 months after surgery); (b) elderly population; (c) a wide range of cognitive functions (memory, attention, concentration, orientation, etc.); (d) the evaluation of risk and protective factors for subsequent POCD development; (e) the relationships between POCD and previous psychological or neuroendocrine factors; (f) the difference on POCD outcomes between different anaesthesia and disorders.

Conclusion

Promoting studies on this topic is significant for the reduction of sociosanitary costs, mortality rates, social dependences and the likelihood of comorbidity.

Bedford PD (1955) Adverse cerebral effects of anaesthesia on old people. Lancet 269(6884):259–263CrossRefPubMed

Rundshagen I (2014) Postoperative cognitive dysfunction. Dtsch Ärzteblatt Int 111(8):119–125. https://doi.org/10.3238/arztebl.2014.0119

Monk TG, Weldon BC, Garvan CW, Dede DE, Van Der Aa MT, Heilman KM, Gravenstein JS (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiol J Am Soc Anesthesiol 108(1):18–30

Bekker AY, Weeks EJ (2003) Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol 17(2):259–272CrossRefPubMed

Newman S, Stygall J, Hirani S, Shaefi S, Maze M (2007) Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology 106(3):572–590CrossRefPubMed

Rasmussen LS, O’brien JT, Silverstein JH, Johnson TW, Siersma VD, Canet J, Jolles J, Hanning CD, Kuipers HM, Abildstrom H, Papaioannou A (2005) Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand 49(9):1225–1231CrossRefPubMed

Wan Y, Xu J, Ma D, Zeng Y, Cibelli M, Maze M (2007) Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflammation in the hippocampus. Anesthesiology 106(3):436–443CrossRefPubMed

Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet 351(9106):857–861CrossRefPubMed

Rasmussen LS, Johnson T, Kuipers HM, Kristensen D, Siersma VD, Vila P, Jolles J, Papaioannou A, Abildstrom H, Silverstein JH, Bonal JA, Raeder J, Nielsen IK, Korttila K, Munoz L, Dodds C, Hanning CD, Moller JT, Investigators I (2003) Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand 47(3):260–266CrossRefPubMed

10.

Davis N, Lee M, Lin AY, Lynch L, Monteleone M, Falzon L, Ispahany N, Lei S (2014) Postoperative cognitive function following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol 26(4):369–376. https://doi.org/10.1097/ANA.0000000000000120 CrossRefPubMedPubMedCentral

11.

Bryson GL, Wyand A (2006) Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth 53(7):669–677. https://doi.org/10.1007/BF03021625 CrossRefPubMed

12.

Mason SE, Noel-Storr A, Ritchie CW (2010) The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 22(Suppl 3):67–79. https://doi.org/10.3233/JAD-2010-101086 CrossRefPubMed

13.

Dale MT, Naik R, Williams JP, Lloyd AJ, Thompson JP (2005) Impairment of sustained attention after major gynaecological surgery. Eur J Anaesthesiol 22(11):843–847. https://doi.org/10.1017/S0265021505001420 CrossRefPubMed

14.

Chen C, Xu GH, Li YH, Tang WX, Wang K (2016) Selective impairment of attention networks during propofol anesthesia after gynecological surgery in middle-aged women. J Neurol Sci 363:126–131. https://doi.org/10.1016/j.jns.2016.02.037 CrossRefPubMed

15.

Altun C, Borazan H, Sahin O, Gezginc K (2015) Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section. J Turk Ger Gynecol Assoc 16(4):219–225. https://doi.org/10.5152/jtgga.2015.15073 CrossRefPubMedPubMedCentral

16.

Xu GH, Zhang QM, Chen C, Shen QY, Liu XS, Shi JF, Gu EW, Li YH, Wang K (2016) Comparison of the type and severity of early attentional network decline after total intravenous or epidural anesthesia in middle-aged women after gynecological surgery. Int Clin Psychopharmacol 31(5):293–299. https://doi.org/10.1097/YIC.0000000000000129 CrossRefPubMed

17.

Zhang D, Nie A (2016) Assessment of different anesthesia depth under total intravenous anesthesia on postoperative cognitive function in laparoscopic patients. J Res Med Sci Off J Isfahan Univ Med Sci 21:73. https://doi.org/10.4103/1735-1995.189679

18.

Shu AH, Wang Q, Chen XB (2015) Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial. Curr Med Res Opin 31(10):1883–1887. https://doi.org/10.1185/03007995.2015.1075968 CrossRefPubMed

19.

Liu LL, Bao N, Lu HW (2016) Effects of CO₂ pneumoperitoneum on the cognitive function of patients undergoing gynecologic laparoscopy. Gynecol Obstet Investig 81(1):90–95. https://doi.org/10.1159/000376576 CrossRef

20.

Biedler A, Juckenhofel S, Feisel C, Wilhelm W, Larsen R (2000) Cognitive impairment in the early postoperative period after remifentanil-propofol and sevoflurane-fentanyl anesthesia. Anaesthesist 49(4):286–290. https://doi.org/10.1007/s001010050830 CrossRefPubMed

21.

Aubrun F, Gaillat C, Rosenthal D, Dupuis M, Mottet P, Marchetti F, Coriat P, Riou B (2008) Effect of a low-dose ketamine regimen on pain, mood, cognitive function and memory after major gynaecological surgery: a randomized, double-blind, placebo-controlled trial. Eur J Anaesthesiol 25(2):97–105. https://doi.org/10.1017/S0265021507002566 CrossRefPubMed

22.

Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS, Group I (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110(3):548–555. https://doi.org/10.1097/aln.0b013e318195b569 CrossRefPubMed

23.

Silverstein JH, Allore HG, Deiner S, Sano M, Rasmussen L (2010) Is postoperative cognitive decline clinically relevant? Anesthesiology 112(5):1280–1281. https://doi.org/10.1097/aln.0b013e3181d690a6 (author reply 1283–1285) CrossRefPubMedPubMedCentral

24.

Van Arsdale A, Rosenbaum D, Kaur G, Pinto P, Kuo DY, Barrera R, Goldberg GL, Nevadunsky NS (2016) Prevalence and factors associated with cognitive deficit in women with gynecologic malignancies. Gynecol Oncol 141(2):323–328. https://doi.org/10.1016/j.ygyno.2016.03.001 CrossRefPubMed

Title: Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications
Authors: Cristina Zarbo
Michela Brivio
Agostino Brugnera
Chiara Malandrino
Gaetano Trezzi
Massimo Rabboni
Emi Bondi
Angelo Compare
Luigi Frigerio
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4630-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications

Abstract

Objective

Methods

Result

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Is fertility-preservation safe for adult non-metastatic gynecologic rhabdomyosarcoma patients? Systematic review and pooled survival analysis of 137 patients

Screening and treatment for short cervical length in pregnancy: a physician survey in the United States

Clinicopathological and prognostic significance of blood microvessel density in endometrial cancer: a meta-analysis and subgroup analysis

Changes in birth-related pain perception impact of neurobiological and psycho-social factors

Fully sialylated alpha-chain of complement 4-binding protein (A2160): a novel prognostic marker for epithelial ovarian carcinoma

The impact of third-trimester genetic counseling