Postoperative neurocognitive disorders

A decline in cognitive function is a frequent complication after major surgery. Postoperative cognitive impairments have generally been divided into short (postoperative delirium) and long-term disturbances (postoperative cognitive dysfunction [POCD]). Long-term impairments are often subtle and overlooked. They need to be objectively assessed with neuropsychological tests in order to be diagnosed. Although POCD has been the subject of considerable research over the past decades, it remains uncertain why some patients do not return to preoperative levels of cognitive function. Surgery and anesthesia have both been implicated in playing a role in developing POCD, and certain patient-related factors, such as advanced age and low preoperative baseline cognitive function have consistently been found to predict postoperative cognitive decline. This article will provide an overview of POCD, and its etiology, and provide advice on possible strategies on preventing it

PEACHY, another fruitful study

The results of the PErioperAtive CHildhood ObesitY (PEACHY) study showed an alarmingly high incidence of obesity amongst children presenting for surgical procedures under general anaesthesia in the UK. The study was performed by the Paediatric Anaesthesia Trainee Research Network (PATRN), a network of trainee anaesthetists seeking to quantify important clinical problems. Networks and consortia that facilitate collaboration amongst clinicians and academics working in a wide range of types of hospitals are particularly important in the current era, as they have the potential to gather data rapidly on important clinical problems, and by their size improve the power to identify factors associated with rare complications. Collaboration amongst clinicians within networks instead of competition between clinicians can have wide-ranging benefits that extend beyond research, and can include improvements in training, rapid dissemination of protocols, and knowledge concerning new problems, ultimately improving general standards of care

Volatile anaesthetics and positive pressure ventilation reduce left atrial performance: a transthoracic echocardiographic study in young healthy adults

Background Animal and in vitro studies suggest that volatile anaesthetics affect left atrial (LA) performance. We hypothesized that human LA pump function and dimensions are altered by volatile anaesthetics in vivo. Methods We performed transthoracic echocardiographic (TTE) measurements in 59 healthy subjects (aged 18-48 yr) undergoing minor surgery under general anaesthesia. The unpremedicated patients were randomly assigned to anaesthesia with sevoflurane, desflurane, or isoflurane. TTE examinations were performed at baseline and after induction of anaesthesia and upon placement of a laryngeal mask during spontaneous breathing. After changing to intermittent positive pressure ventilation (IPPV), an additional TTE was performed. The study focused on the velocity-time integral of late peak transmitral inflow velocity (AVTI) and maximum LA volume. Results We found no evidence for relevant differences in the effects of the three volatile anaesthetics. AVTI decreased significantly from 4.1 (1.2) cm at baseline to 3.2 (1.1) cm during spontaneous breathing of 1 minimum alveolar concentration of volatile anaesthetics. AVTI decreased further to 2.8 (1.0) cm after changing to IPPV. The maximum LA volume was 45.4 (18.6) cm3 at baseline and remained unchanged during spontaneous breathing but decreased to 34.5 (16.7) cm3 during IPPV. Other parameters of LA pump function and dimensions decreased similarly. Conclusions Volatile anaesthetics reduced active LA pump function in humans in vivo. Addition of IPPV decreased LA dimensions and further reduced LA pump function. Effects in vivo were less pronounced than previously found in in vitro and animal studies. Further studies are warranted to evaluate the clinical implications of these findings. Clinical trial registration NCT002445

BIS and spectral entropy monitoring during sedation with midazolam/remifentanil and dexmedetomidine/remifentanil

Haenggi and colleagues report considerable intra- and inter-individual variability in derived electroencephalogram (EEG) parameters (Bispectral Index (BIS), response entropy and state entropy) recorded in volunteers sedated with midazolam or dexmedetomidine infusions titrated to modified Ramsay scores of 2, 3 and 4, and a remifentanil infusion at a fixed target concentration. Possible explanations for the low, variable and fluctuating EEG parameters are that volunteers were intermittently asleep, and that remifentanil gave rise to a low amplitude, slowed EEG pattern despite maintained consciousness. BIS and entropy values should be interpreted in combination with clinical findings in patients sedated with these agents

Smoking Cessation Interventions for COPD: A Review of the Literature

The aim of this systematic review is to establish the most effective stop smoking intervention approach for smokers with COPD. The search strategy included the electronic databases MEDLINE, EMBASE, AMED, PsycINFO, DARE, Cochrane Library, and CINAHL, between January 2006 and January 2010. References of the included studies were also screened for additional papers, and further hand searches were conducted. The selection criteria included randomized controlled trials or quasi-randomized controlled trials with at least one subject group diagnosed with COPD. Two independent reviewers reviewed the included studies, using a quality assessment form developed from the selection criteria. Divergence of quality assessment scores was resolved by the 2 reviewers agreeing on a score. The 4 studies selected indicate that psychosocial interventions combined with pharmacotherapy are effective in smoking cessation at 12 months post-intervention, although the effect is not statistically significant, due to small sample size and heterogeneity between the studies (odds ratio 2.35, 95% CI 0.25–21.74,). However, despite this medium effect size, due to a lack of universal use of pharmacotherapies in most of the studies, it makes a definitive comparison of efficacy difficult to determine. This review also shows the effectiveness of psychosocial treatment for people with or without COPD symptoms at 12 months, although the effect of disease severity is not clear. This review also highlights the difficulty of maintaining attendance at community-based locations, compared to acute or research settings