由sevoflurane麻醉引起的认知障碍在老年患者的胃肠道手术后由胆固醇系统介导:一项随机对照试验:
Xing-Xing Liu1, Qing-Xu Yang2, Yi Guo3
1Department of Anesthesiology Affiliated Hospital of Zunyi Medical University Zunyi Guizhou P.R. China.
Ibrain
|September 30, 2024
概括
在老年手术患者中,sevoflurane麻醉可能会导致短期认知能力下降,这可能与中枢胆固醇系统有关. 普罗波麻醉似乎可以提供更好的短期神经认知恢复.
科学领域:
- 麻醉学 麻醉学
- 神经科学是一个神经科学.
- 老年医学 老年医学
背景情况:
- 手术后神经认知恢复延迟会增加患者的发病率和死亡率.
- 延迟神经认知恢复背后的机制是复杂的和有争议的.
- 老年人特别容易患上术后神经认知缺陷.
研究的目的:
- 为了比较基于sevoflurane和基于propofol的麻醉对老年手术患者神经认知恢复的影响.
- 调查麻醉剂与胆固醇功能神经化学标记物之间的关联.
- 确定不同麻醉技术对认知功能的短期影响.
主要方法:
- 一项前性,双盲,随机对照试验,涉及75名接受胃肠道手术的老年患者 (≥65岁).
- 患者被随机分配,接受基于sevoflurane或基于propofol的麻醉.
- 使用迷你精神状态检查 (MMSE) 评估认知功能,并测量胆转移酶 (CHAT) 和乙胆酶 (AChE) 的血液水平.
主要成果:
- 在手术后的第一天,接受了西沃弗兰麻醉的患者在MMSE得分上表现明显差,相比于普罗波组.
- 在术后第一天,在赛沃兰组观察到较低的CHAT和较高的ACHE水平.
- 在手术后的第三天,两组之间没有发现MMSE得分或胆性标记的显著差异.
结论:
- 在老年手术患者中,基于sevoflurane的麻醉与短期延迟的神经认知恢复有关.
- 这种短期的缺陷可能与中枢胆固醇系统的改变有关.
- 基于普罗波的麻醉似乎在这个患者群体中促进了更快的神经认知恢复.
相关概念视频
Stages of General Anesthesia
383
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
383
General Anesthesia: Overview
196
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
196
Inhalational Anesthetics: Overview
228
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
228
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
57
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
57
Skeletal Muscle Relaxants: Adverse Effects
345
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
345
Parenteral Anesthetics: Overview
107
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
107


