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Postoperative kognitive Dysfunktion

Inzidenz und Prophylaxe

Postoperative cognitive dysfunction

Incidence and prophylaxis

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Zusammenfassung

Die Inzidenz der postoperativen kognitiven Dysfunktion (POCD) wird oft unterschätzt und ist vielen Anästhesisten nicht unmittelbar präsent. Die POCD tritt häufig bei älteren Patienten auf, kann aber auch bei jungen Patienten vorkommen. Ihre Prävalenz nach großen nichtherzchirurgischen Eingriffen 7 Tage postoperativ liegt bei 19–41% in den Altersklassen der über 18-Jährigen. Drei Monate postoperativ ist nur in der Altersgruppe der über 60-Jährigen eine erhöhte POCD-Rate (10%) nachweisbar. Das Auftreten der POCD ist mit einer erhöhten Mortalitätsrate assoziiert. Die Ätiologie ist trotz aller wissenschaftlichen Bemühungen weitgehend ungeklärt. Das Patientenalter stellt einen Risikofaktor dar. Die Studienlage zur Prophylaxe der POCD ist limitiert. Die Aufrechterhaltung der Homöostase des Patienten ist ein wichtiger Eckpunkt der Prophylaxe.

Abstract

The incidence of postoperative cognitive dysfunction (POCD) is often underestimated and not intuitively present by many anesthetists. POCD often occurs in the elderly but is also seen in younger patients. The incidence of POCD 1 week after non-cardiac surgery covers a span between 19–41% in patients older than 18 years. An increased POCD rate (10%) 3 months after surgery is only detected in patients older than 60 years. The occurrence of POCD is associated with an increased mortality rate, jet the etiology is mainly unknown despite enormous research efforts. The age of the patient is one of the main risk factors for the development of POCD. Data on how to avoid POCD are limited. However, the maintenance of homoeostasis is an important cornerstone of prophylaxis.

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Literatur

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

    Article  CAS  PubMed  Google Scholar 

  2. Steinmetz J, Christensen KB, Lund T et al (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110:548–555

    Article  PubMed  Google Scholar 

  3. Monk TG, Weldon BC, Garvan CW et al (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18–30

    Article  PubMed  Google Scholar 

  4. Newman S, Stygall J, Hirani S et al (2007) Postoperative cognitive dysfunction after noncardiac surgery. Anesthesiology 106:572–590

    Article  PubMed  Google Scholar 

  5. Dyer CB, Ashton CM, Teasdale TA (1995) Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 155:461–465

    Article  CAS  PubMed  Google Scholar 

  6. Rasmussen LS, Larsen K, Houx P et al (2001) The assessment of postoperative cognitive function. Acta Anaesthesiol Scand 45:275–289

    Article  CAS  PubMed  Google Scholar 

  7. Silverstein JH, Timberger M, Reich DL et al (2007) Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology 106:622–628

    Article  PubMed  Google Scholar 

  8. Lewis M, Maruff P, Silbert B (2004) Statistical and conceptual issues in defining post-operative cognitive dysfunction. Neurosci Biobehav Rev 28:433–440

    Article  PubMed  Google Scholar 

  9. Moller J, Cluitmans P, Rasmussen L et al (1998) Long-term postoperative cognitive dysfunction in the elderly; ISPOCD1 study. Lancet 351:857–861

    Article  CAS  PubMed  Google Scholar 

  10. Johnson T, Monk T, Rasmusen LS et al (2002) Postoperative cognitive dysfunction in middle aged patients. Anesthesiology 96:1351–1357

    Article  PubMed  Google Scholar 

  11. Abildstrom H, Rasmussen LS, Rentowl P et al (2000) Cognitive dysfunction 1–2 years after non-cardiac surgery in the elderly. Acta Anaesthesiol Scand 44:1246–1251

    Article  CAS  PubMed  Google Scholar 

  12. Canet J, Raeder J, Rasmussen LS et al (2003) Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 47:1204–1210

    Article  CAS  PubMed  Google Scholar 

  13. Poirier J, Davignon J, Bouthillier D et al (1993) Apolipoprotein E polymorphism and Alzheimer’s disease. Lancet 342:697–699

    Article  CAS  PubMed  Google Scholar 

  14. Abildstrom H, Christiansen M, Siersma VD et al (2004) Apolipoprotein E genotype and cognitive dysfunction after noncardiac surgery. Anesthesiology 101:855–861

    Article  CAS  PubMed  Google Scholar 

  15. Dantzer R (2001) Cytokine-induced sickness behavior: where do we stand? Brain Behav Immun 15:7–24

    Article  CAS  PubMed  Google Scholar 

  16. Wan Y, Xu J, Ma D (2007) Postoperative impairment of cognitive function in rats. A possible role for cytokine-mediated inflammation in the hippocampus. Anesthesiology 106:436–443

    Article  PubMed  Google Scholar 

  17. Rasmussen LS, O’Brien JT, Silverstein JH et al (2005) Is peri-operative cortisol secretion related to postoperative cognitive dysfunction? Acta Anaesthesiol Scand 49:1225–1231

    Article  CAS  PubMed  Google Scholar 

  18. Mulsant BH, Pollock BG, Kirshner M et al (2003) Serum anticholinergic activity in a community-based sample of older adults. Arch Gen Psychiatry 60:198–203

    Article  CAS  PubMed  Google Scholar 

  19. Stockton P, Cohen-Mansfield J, Billing N (2000) Mental status change in older surgical patients: Cognition, depression, and other comorbidity. Am J Geriatr Psychiatry 8:40–46

    Article  CAS  PubMed  Google Scholar 

  20. Ancelin ML, Roquefeuil G de, Ledesert B et al (2001) Exposure to anaesthetic agents, cognitive function and depressive symptomatology in the elderly. Br J Psychiatry 178:360–366

    Article  CAS  PubMed  Google Scholar 

  21. Rudolph JL, Marcantonio ER, Culley DJ et al (2008) Delirium is associated with early postoperative cognitive dysfunction. Anaesthesia 63:941–947

    Article  CAS  PubMed  Google Scholar 

  22. Hudetz JA, Iqbal Z, Gandhi SD et al (2007) Postoperative cognitive dysfunction in older patients with a history of alcohol abuse. Anesthesiology 106:423–430

    Article  PubMed  Google Scholar 

  23. Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment, 4th edn. Oxford University Press, New York

  24. Price CC, Garvan CW, Monk TG (2008) Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology 108:9–17

    Article  Google Scholar 

  25. Rasmussen LS, Steentoft A, Rasmussen H et al (1999) Benzodiazepines and postoperative cognitive dysfunction in the elderly. Br J Anaesth 83:585–589

    CAS  PubMed  Google Scholar 

  26. Fong HK, Sands LP, Leung JM (2006) The role of postoperative analgesia in delirium and cognitive decline in elderly: a systematic review. Anesth Analg 102:1255–1266

    Article  PubMed  Google Scholar 

  27. Rasmussen LS, Johnson T, Kuipers HM et al (2003) Does anaesthesia cause postoperative cognitive dysfunction? A randomized study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand 47:260–266

    Article  CAS  PubMed  Google Scholar 

  28. Enlund M, Mentell O, Flenninger A et al (1998) Evidence of cerebral dysfunction associated with isoflurane or propofol based anaesthesia for orthognatic surgery, as assessed by biochemical and neuropsychological methods. Ups J Med Sci 103:43–59

    Article  CAS  PubMed  Google Scholar 

  29. Höcker J, Stapelfeldt C, Leiendecker J et al (2009) Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study. Anesthesiology 110:1068–1076

    Article  PubMed  Google Scholar 

  30. Coburn M, Baumert JH, Roertgen D et al (2007) Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial. Br J Anaesth 98:756–762

    Article  CAS  PubMed  Google Scholar 

  31. Gao L, Taha R, Gauvin D (2005) Postoperative cognitive dysfunction after cardiac surgery. Chest 128:3664–3670

    Article  PubMed  Google Scholar 

  32. Jhaveri RM (1989) The effects of hypocapnic ventilation on mental function in elderly patients undergoing cataract surgery. Anaesthesia 44:635–640

    Article  CAS  PubMed  Google Scholar 

  33. Duggleby W, Lander L (1994) Cognitive status and postoperative pain: older adults. J Pain Symptom Manage 9:19–27

    Article  CAS  PubMed  Google Scholar 

  34. Inouye SK (2006) Delirium in older persons. N Engl J Med 354:1157–1165

    Article  CAS  PubMed  Google Scholar 

  35. Riis J, Lomholt B, Haxholdt O et al (1983) Immediate and long-term mental recovery from general versus epidural anesthesia in elderly patients. Acta Anaesthesiol Scand 27:44–49

    Article  CAS  PubMed  Google Scholar 

  36. Bigler D, Adelhoj B, Petring OU et al (1985) Mental function and morbidity after acute hip surgery during spinal and general anaesthesia. Anaesthesia 40:672–676

    Article  CAS  PubMed  Google Scholar 

  37. Hughes D, Bowes JB, Brown MW (1988) Changes in memory following general or spinal anaesthesia for hip arthroplasty. Anaesthesia 43:114–117

    Article  CAS  PubMed  Google Scholar 

  38. Ghoneim MM, Hinrichs JV, O’Hara MW et al (1988) Comparison of psychologic and cognitive functions after general or regional anesthesia. Anesthesiology 69:507–515

    Article  CAS  PubMed  Google Scholar 

  39. Williams-Russo P, Sharrock NE, Mattis S et al (1995) Cognitive effects after epidural vs general anaesthesia in older adults. A randomized trial. JAMA 274:44–50

    Article  CAS  PubMed  Google Scholar 

  40. Nielson WR, Gelb AW, Casey JE et al (1990) Long-term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly. Anesthesiology 73:1103–1109

    Article  CAS  PubMed  Google Scholar 

  41. Haan J, Kleef JW van et al (1991) Cognitive function after spinal or general anesthesia for transurethral prostatectomy in elderly men. J Am Geriatr Soc 39:596–600

    CAS  PubMed  Google Scholar 

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  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    M. Coburn, A. Fahlenkamp, N. Zoremba & G. Schaelte

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  1. M. Coburn
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  2. A. Fahlenkamp
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  3. N. Zoremba
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  4. G. Schaelte
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Correspondence to M. Coburn.

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Coburn, M., Fahlenkamp, A., Zoremba, N. et al. Postoperative kognitive Dysfunktion. Anaesthesist 59, 177–185 (2010). https://doi.org/10.1007/s00101-009-1657-2

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