Summary
Cognitive decline is a common complication after cardiac surgery with cardiopulmonary bypass (CPB), but as such no pharmacological therapy has been shown to be efficacious in preventing the decline. However, gastrodin has been shown to have multi-pharmacological effects on neurological functions. We undertook this study to test the hypothesis that gastrodin would potentially prevent CPB-associated neurocognitive decline. We randomly assigned 200 patients undergoing mitral valve replacement surgery to receive either gastrodin (40 mg/kg) or saline after the induction of anesthesia and subsequently evaluated cognitive function before surgery, at discharge, and at 3rd month after surgery by using a battery of five neurocognitive tests, or adverse effects of gastrodin postoperatively. Neurocognitive decline in postoperative function was defined as a drop of 1 SD or more in the scores on tests of any one of the four domains of cognitive function. Cognitive decline occurred in 9% of the patients in the gastrodin group in contrast to 42% in the control group (P<0.01) at discharge. Cognitive outcome could be determined at 3rd month in 87 patients in the gastrodin group and 89 in the control group. Cognitive decline was detected in 6% in the gastrodin group and 31% in the control group (P<0.01). The incidences of possible adverse effects were similar between two groups. These results indicate that gastrodin is an effective and a safe drug for the prevention of neurocognitive decline in patients undergoing mitral valve replacement surgery with CPB.
References
Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary artery bypass surgery. N Engl J Med, 2001, 344(6):395–402
Selnes OA, Goldsborough MA, Borowicz LM, et al. Neurobehavioral sequelae of cardiopulmonary bypass. Lancet, 1999,353(9164):1601–1606
Lund C, Hol PK, Lundblad R, et al. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg, 2003, 76(3):765–770
Brown WR, Moody DM, Challa VR, et al. Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli. Stoke, 2000, 31(3):707–713
Sato Y, Laskowitz DT, Bennett ER, et al. Differential cerebral gene expression during cardiopulmonary bypass in the rat: evidence for apoptosis? Anesth Analg, 2002,94(6):1389–1394
Siesjö BK, Zhao Q, Pahlmark K, et al. Glutamate, calcium, and free radicals as mediators of ischemic brain damage. Ann Thorac Surg, 1995,59(5):1316–1320
Murkin JM. Attenuation of neurologic injury during cardiac surgery. Ann Thorac Surg, 2001,72(5):S1838–S1844
Tseng EE, Brock MV, Kwon CC, et al. Increased intracerebral excitatory amino acids and nitric oxide after hypothermic circulatory arrest. Ann Thorac Surg, 1999, 67(2):371–376
Chakravarthy M, Manjunath V, Javali V, et al. Neurocognitive behavior changes in patients undergoing off pump coronary artery bypass surgery: A prospective observational study. J Anaesth Clin Pharmacol, 2008, 24(1):45–52
Raja PV, Blumenthal JA, Doraiswamy MP. Cognitive deficits following coronary artery bypass grafting: prevalence, prognosis, and therapeutic strategies. CNS Spect, 2004,9(10):763–772
Yu SJ, Kim JR, Lee CK, et al. Gastrodia elata Blume and an active component, p-hydroxybenzyl alcohol reduce focal ischemic brain injury through antioxidant related gene expressions. Biol Pharm Bull, 2005, 28(6):1016–1020
Hsieh CL, Chen CL, Tang NY, et al. Gastrodia elata BL mediates the suppression of nNOS and microglia activation to protect against neuronal damage in kainic acid-treated rats. Am J Chin Med, 2005,33(4):599–611
Kim HJ, Lee SR, Moon KD. Ether fraction of methanol extracts of Gastrodia elata, medicinal herb protects against neuronal cell damage after transient global ischemia in gerbils. Phytother Res, 2003,17(8):909–912
Kim HJ, Moon KD, Oh SY, et al. Ether fraction of methanol extracts of Gastrodia elata, a traditional medicinal herb, protects against kainic acid-induced neuronal damage in the mouse hippocampus. Neurosci Lett, 2001,314(1–2):65–68
Lee YS, Ha JH, Yong CS, et al. Inhibitory effects of constituents of Gastrodia elata Bl. on glutamate -induced apoptosis in IMR-32 human neuroblastoma cells. Arch Pharm Res, 1999,22(4):404–409
Huang NK, Lin YL, Cheng JJ, et al. Gastrodia elata prevents rat pheochromocytoma cells from serum-deprived apoptosis: the role of the MAPK family. Life Sci, 2004,75(13):1649–1657
Andersson M, Bergendorff O, Nielsen M, et al. Inhibition of kainic acid binding to glutamate receptors by extracts of Gastrodia. Phytochemistry, 1995,38(4):835–836
Ha JH, Lee DU, Lee JT, et al. 4-Hydroxybenzaldehyde from Gastrodia elata B1 is active in the antioxidation and GABAergic neuromodulation of the rat brain. J Ethnopharmacol, 2000,73(1–2):329–333
Li HB, Chen F. Preparative isolation and purification of gastrodin from the Chinese medicinal plant Gastrodia elata by high-speed counter-current chromatography. J Chromatogr A, 2004,1052(1–2):229–232
Lin LY, Chen YF, Tsai TR, et al. Analysis of brain distribution and biliary excretion of a nutrient supplement, gastrodin, in rat. Anal Chim Acta, 2007,590(2): 173–179
Xu X, Lu Y, Bie X. Protective effects of gastrodin on hypoxia-induced toxicity in primary cultures of rat cortical neurons. Planta Med, 2007,73(7):650–654
Zeng X, Zhang S, Zhang L, et al. A study of the neuroprotective effect of the phenolic glucoside gastrodin during cerebral ischemia in vivo and in vitro. Planta Med, 2006,72(15):1359–1365
Zeng X, Zhang Y, Zhang S, et al. A microdialysis study of effects of gastrodin on neurochemical changes in the ischemic/reperfused rat cerebral hippocampus. Biol Pharm Bull, 2007,30(4):801–804
Hsieh MT, Wu CR, Chen CF. Gastrodin and p-hydroxy benzyl alcohol facilitate memory consolidation and retrieval, but not acquisition, on the passive avoidance task in rats. J Ethnopharmacol, 1997,56(1): 45–54
Zhang S, Wang S, Li Q, et al. Capillary leak syndrome in children with C4A-deficiency undergoing cardiac surgery with cardiopulmonary bypass: a double-blind, randomized controlled study. Lancet, 2005,366(9485): 556–562
Zhang S, Wang S, Yao S. Evidence for development of capillary leak syndrome associated with cardiopulmonary bypass in pediatric patients with the homozygous C4A null phenotype. Anesthesiology, 2004,100(6): 1387–1393
Murkin JM, Newman SP, Stump DA, et al. Statement of consensus of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg, 1995,59(5):1289–1295
Rasmussen LS, Larsen K, Houx P, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand, 2001,45(3):275–289
Newman MF, Grocott HP, Mathew JP, et al. Report of the substudy of assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stoke, 2001,32(12):2874–2881
Grocott HP, Mackensen GB, Grigore AM, et al. Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery. Stoke, 2002,33(2):537–541
Wang X, Yao S, Kirkpatrick B, et al. Psychopathology and neuropsychological impairment in deficit and nondeficit schizophrenia of Chinese origin. Psychiatry Res, 2008,158(2):195–205
Brækken SK, Reinvang I, Russell D, et al. Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J Neurol Neurosurg Psychiatry, 1998,65(4):573–576
van Dijk D, Jansen EWL, Hijman R, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery, a randomized trial. JAMA, 2002, 287(11):1405–1412
Jonsson H, Johnsson P, Alling C, et al. S100beta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome. Ann Thorac Surg, 1999,68(6):2202–2208
Herrmann M, Ebert AD, Galazky I, et al. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke, 2000,31(3):645–650
van Dijk D, Spoor M, Hijman R, et al. Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. JAMA, 2007, 297(7):701–708
Newman MF, Croughwell ND, White WD, et al. Pharmacologic electroencephalographic suppression during cardiopulmonary bypass: a comparison of thiopental and isoflurane. Anesth Analg, 1998,86(2):246–251
Selnes OA, Goldsborough MA, Borowicz LM Jr, et al. Determinants of cognitive change after coronary artery bypass surgery: a multifactorial problem. Ann Thorac Surg, 1999,67(6):1669–1676
Jung JW, Yoon BH, Oh HR, et al. Anxiolytic-like effects of Gastrodia elata and its phenolic constituents in mice. Biol Pharm Bull, 2006,29(2):261–265
Gao Z, Tan T, Zhong Y, et al. Study of the mechanism of gastrodin and derivatives of gastrodigenin. Hua Xi Yi Ke Da Xue Xue Bao (Chinese), 1991,22(1):79–82
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This study was supported partly by grants from the National Natural Sciences Foundation of China (No. 30271255) and the Natural Sciences Foundation of Hubei Province, China (No. 2006ABB023).
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Zhang, Z., Ma, P., Xu, Y. et al. Preventive effect of gastrodin on cognitive decline after cardiac surgery with cardiopulmonary bypass: A double-blind, randomized controlled study. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 31, 120–127 (2011). https://doi.org/10.1007/s11596-011-0162-4
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DOI: https://doi.org/10.1007/s11596-011-0162-4