Postoperative Cognitive Effects in Newborns The Role of Inflammatory Processes
Department of Anesthesiology, University of Virginia Health System, Charlottesville, -Virginia. .Anesthesiology (Impact Factor: 5.88). 01/2013; 118(3). DOI: 10.1097/ALN.0b013e3182835276
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ABSTRACT: Introduction Trauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia. Method This is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-hours. Results IL- 6 increased significantly at both 5 and further at 24 hours after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24-hours respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p= 0.008) also between 5 h and 24 h, (p= 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-hour MMSE score less than 25 had a significant higher 24-hour IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002). Conclusion The IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE <25 at 24-hours. Further studies are warranted evaluating the role of depth of anaesthesia monitoring on the risk for early cognitive impairment and neuro-inflammation. Trial registration Clinicaltrials.gov identifier: NA /study were conducted between January 2005-April 2008
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