The Trendelenburg Position and Cognitive Decline: A Case-Control Interventional Study Involving Healthy Volunteers

Area of Science:

• Anesthesiology
• Neurosurgery
• Surgical Innovation

Background:

• Postoperative cognitive decline (POCD) is a significant concern following surgical interventions.
• Cognitive function is assessed using validated tests like the N-back, Stroop, and lexical decision-making tasks (LDT).
• Prolonged Trendelenburg positioning in laparoscopic colorectal surgery is suspected to contribute to POCD.

Purpose of the Study:

• To evaluate the impact of sustained Trendelenburg position duration on cognitive function.
• To determine if increased time in Trendelenburg correlates with cognitive impairment.

Main Methods:

• Healthy volunteers underwent 3 hours of Trendelenburg positioning followed by 30 minutes supine.
• Cognitive function was tested at baseline and every 30 minutes using 1-, 2-, 3-back, Stroop, and LDT.
• Cognitive decline was defined as a >2 control group SD increase in response time or decrease in accuracy.

Main Results:

• Fifteen healthy volunteers (average age 69) participated.
• While accuracy remained stable, response times increased, indicating cognitive decline in 20-40% of participants during Trendelenburg.
• Cognitive decline persisted in 33% of participants even after returning to a supine position.

Conclusions:

• Trendelenburg positioning demonstrably leads to cognitive decline.
• Findings suggest potential risks for patients undergoing lengthy laparoscopic colorectal procedures in this position.