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Decrease of Coronal Optic Nerve Sheath Diameter is Associated With Postoperative Cognitive Decline in Patients

Li-Min Zhang1, Yan Li1, Yun-Ting Zhang2

  • 1Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, China.

Journal of Cardiothoracic and Vascular Anesthesia
|November 30, 2020
PubMed
Summary

Postoperative cognitive decline (POCD) after carotid endarterectomy (CEA) is linked to a decrease in optic nerve sheath diameter (ONSD). This ultrasound measurement can help predict POCD risk in patients undergoing CEA.

Keywords:
anesthesiacarotid endarterectomycognitive dysfunctionoptic nerve sheath diameterultrasonography

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Ophthalmology

Background:

  • Carotid endarterectomy (CEA) carries a risk of postoperative cognitive decline (POCD).
  • POCD may stem from cerebral hypotension or hyperperfusion during surgery.
  • Optic nerve sheath diameter (ONSD) correlates with intracranial pressure.

Purpose of the Study:

  • To investigate risk factors for POCD in CEA patients.
  • To assess if a decrease in coronal ONSD predicts POCD incidence.
  • To evaluate ONSD as a non-invasive predictor of POCD.

Main Methods:

  • Observational retrospective study at a single tertiary academic center.
  • Included 116 patients undergoing CEA between January 2019 and December 2019.
  • Analyzed 84 patients using logistic regression and ROC curves to assess ONSD changes.

Main Results:

  • The incidence of POCD within two days post-surgery was 28.6%.
  • Decreased coronal ONSD (OR 0.438, p=0.021) and total intravenous anesthesia (TIVA) (OR 25.541, p=0.011) were independent risk factors for POCD.
  • Change in coronal ONSD showed moderate predictive ability for POCD (AUC 0.716).

Conclusions:

  • A decrease in coronal ONSD, measured via ultrasonography, is associated with POCD after CEA.
  • Total intravenous anesthesia (TIVA) is also a risk factor for POCD.
  • Coronal ONSD change serves as a moderate predictor of POCD incidence.