Daizo Ishii1, Mario Zanaty1, Jorge A Roa2, Luyuan Li1, Yongjun Lu1, Lauren Allan3, Edgar A Samaniego2, James C Torner4, Daniel Tranel2,5, David M Hasan1. 1. Department of Neurosurgery, 21782University of Iowa Hospitals and Clinics, USA. 2. Department of Neurology, 21782University of Iowa Hospitals and Clinics, USA. 3. Department of Surgery, 21782University of Iowa Hospitals and Clinics, USA. 4. Department of Epidemiology, University of Iowa, USA. 5. Department of Psychological and Brain Sciences, University of Iowa, USA.
Abstract
OBJECTIVE: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC). METHODS: We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC. RESULTS: A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42-1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [-0.29-0.67], P = 0.59). CONCLUSIONS: Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.
OBJECTIVE: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC). METHODS: We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC. RESULTS: A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42-1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [-0.29-0.67], P = 0.59). CONCLUSIONS: Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.
Authors: Peter Kan; Shady Jahshan; Parham Yashar; David Orion; Sharon Webb; Adnan H Siddiqui; L Nelson Hopkins; Elad I Levy Journal: Neurosurgery Date: 2013-02 Impact factor: 4.654
Authors: Terri G Monk; B Craig Weldon; Cyndi W Garvan; Duane E Dede; Maria T van der Aa; Kenneth M Heilman; Joachim S Gravenstein Journal: Anesthesiology Date: 2008-01 Impact factor: 7.892
Authors: Daizo Ishii; Luyuan Li; Mario Zanaty; Jorge A Roa; Lauren Allan; Edgar A Samaniego; David M Hasan Journal: Interv Neuroradiol Date: 2020-06-17 Impact factor: 1.610