Issn Print: 0265-0215

Publication Date: 2010/06/12


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The role of cerebral oximetry and plasma levels of: 7AP2–8NMDA: 7AP2–8receptor antibodies (NR2Ab) for diagnostic of postoperative cognitive dysfunction: 7AP2–8

C. Bodolea; A. Oblezniuc; T. Cristea; V. Donca; S. O. Pintea

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Background and Goal of Study: Postoperative cognitive dysfunction (POCD) in the elderly patients is an unwanted complication of the postoperative period. POCD is probable, the result of a neuroinflammatory process and it is only detectable through the usage of neuropshycological tests. The aim of the study is to evaluate the importance of the following factors in the developement of POCD: the individual risk factors, the intra or postoperative occurence of cerebral desaturation episodes (NIRS) and cerebral ischemia, quantified by detection of high plasma concentration of NMDA receptor antibodies (NR2Ab).
Materials and Methods: The pilot, prospective, randomised ethically approved and consented study enrolled 50 ASA I - III patients, aged over 65. 25 patients were scheduled for urologic surgery (group S) and have been compared with 25 nonsurgical subjects (group NS). The NS group was divided in two subgroups: 15 in-hospital patients, with medical diseases (group NSH) and 10 control not-hospitalised elderly, (group NSNH).Neuropshycological tests have been applied in all patients preoperatively (group S) or as a primary evaluation (group NS) and, subsequently, at 10 days, 1,3 and 12 months postoperative or post primary evaluation. Group S was also divided in two subgroups: 16 patients with cerebral oximetry monitoring 24 hours from the beginning of the surgical procedure (group SX) and 9 patients with standard monitoring but without cerebral oximetry (group SNX). Plasma levels of NR2Ab were recorded preoperative or on primary evaluation and at one month. POCD was defined by a composite Z score >1,96 and the SX group has been compared with the other groups. Fischer exact and t test were used and p<0.05 was considered significant.
Results and Discussion: Compared with the NS group, the incidence of POCD in group S was significantly higher (p<0.01) at 10 days and 1 month postoperatively but not at 3 and 12 months. There were no differences in POCD incidence at any time, while comparing any other groups, including SX group compared with SNX group and NSNH group compared with NSH group. Regarding the NR2Ab plasma levels, at 1 month postoperatively there were no differences between the POCD patients of group S when compared with the patients of group NS (1.78±0,63 vs 1.6±0,45 ng/dL).
Conclusion(s): In a pilot study, POCD after urologic surgery has a maximum incidence in the first month postoperatively regardless the use of cerebral oximetry monitoring and without significant increase of NR2Ab plasma levels, making improbable a cerebral ischemic ethiology.
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