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Perioperative hyperglycemia and neurocognitive outcome after surgery: a systematic review
No full texta B
introDUction: Preliminary evidence suggest a possible relationship between perioperative
hyperglycemia, postop- erative delirium (PoD) or cognitive dysfunction (PocD). We aim to present
the available clinical evidence related to chronic (i.e. diabetes mellitus) or acute perioperative
hyperglycemia as risk factors for PoD/PocD.
eviDence acQUisition: a literature search of eMBase (via ovid, 1974-present) online medical
database and MeDline (via PubMed or ovid, 1946-present) was performed. all types of clinical
studies including randomized con- trolled trials, prospective, as well as retrospective cohort
studies were screened. clinical studies that reported original information on the relationship
between diabetes mellitus (DM) and/or acute perioperative abnormal glucose levels and PoD or PocD
were selected. reviews and editorials (i.e. articles not presenting original preclinical or
clinical research) were excluded and case-reports were not considered for analysis.
eviDence sYntHesis: our search resulted in 2356 papers for screening, from which we selected 29
studies that met our inclusion criteria. DM was investigated in 24 observational papers, acute
perioperative hyperglycemia in six obser- vational studies and two randomized controlled trials
examined the effect of perioperative glucose lowering on PoD/ PocD. Diabetes was associated with
PoD or PocD in 18/24 observational studies and 6/6 of the included observational studies found that
perioperative hyperglycemia was associated with PoD/PocD, independent of diabetes. the two ran-
domized controlled trials had a different trial design and reported conflicting results.
conclUsions: according to the available evidence, DM and acute perioperative hyperglycemia may be
associated with an increased risk for PoD/PocD. these conclusions are based mostly on observational
studies and deserve more and dedicated research. this systematic review may direct the design of
future studies.
(Cite this article as: Hermanides J, Qeva e, Preckel B, Bilotta F. Perioperative hyperglycemia and
neurocognitive outcome after surgery: a systematic review. Minerva anestesiol 2018;84:1178-88. Doi:
10.23736/s0375-9393.18.12400-X)
Key words: Hyperglycemia - cognitive dysfunction - Delirium - Diabetes mellitus - Postoperative
complications
Anesthesia and cognitive disorders: a systematic review of the clinical evidence
No full textAbstract
Introduction: Preclinical and clinical evidence suggest an association between
anesthesia and cognitive disorders ranging from postoperative chronic dysfunction to
Alzheimer’s disease. Recent clinical insights are summarized in this paper.
Areas covered: This systematic review was conducted and written in accordance with
the PRISMA statement and was registered in the International Prospective Register of
Systematic Review database. A literature search of PubMed, EMBASE and SCOPUS
was accomplished according to a written protocol that included: clinical trials on
humans, articles in English, papers published between April 2010 and February 2016
and complete studies.
Expert commentary: There is a growing interest in establishing the possible relationship
between anesthesia and the onset and progression of cognitive disorders. Further
studies are required to determine the methods of monitoring anesthesia in older adults
with dementia undergoing surgical procedures.
Keywords: anesthesia and Alzheimer, postoperative cognitive dysfunction,
cerebrospinal fluid and Alzheimer’s disease (AD) biomarkers, β-amyloid protein to tau
ratio, Bispectral (BIS) – guided anesthesia and postoperative cognitive dysfunction
(POCD), anesthetics and AD biomarke
Perioperative cognitive evaluation
No full textPerioperative cognitive evaluation
Anastasia Borozdinaa, Ega Qevab, Marco Cinicolab, and Federico Bilottab
Purpose of review
This article reviews the recent clinical evidence published between January 2017 and June 2018 –
related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention,
diagnosis and diagnostic tools and treatment.
Recent findings
Several risk factors (preoperative, intraoperative and postoperative) have been found to be
associated with the development of postoperative delirium (POD) and/or postoperative cognitive
dysfunction (POCD).
Short-term and long-term postoperative consequences can be reduced by targeting risk factors,
introducing preventive strategies and including frequent cognitive monitoring. Administration of
medications such as ketamine, opioids and benzodiazepines are associated with increased
cognitive dysfunction. Prevention of POD/POCD starts with creating an environment, which promotes
return to preoperative baseline functioning. This includes frequent monitoring of cognitive status,
access to rehabilitation and psychological and social supports, and avoiding polypharmacy. In
addition, patients should have early access to their sensory aids and maintain normal circadian
rhythm. Treatment of POD/POCD has pharmacological and nonpharmacological approaches.
Summary
Clinical evidence on POD/POCD is continuously evolving, which is essential in guiding clinical
management to provide the highest quality of clinical care.
Keywords
cognitive evaluation, postoperative cognitive dysfunction, postoperative deliriu
Effects of propofol or sevoflurane anesthesia induction on hemodynamics in patients undergoing fiberoptic intubation for cervical spine surgery: A randomized, controlled, clinical trial
No full textBackground and Aims: In patients undergoing surgery for cervical myelopathy, induction of general anesthesia can induce
systemic arterial hypotension that may worsen spinal cord hypoperfusion and precipitate spinal injury. In this randomized,
controlled, clinical trial study, we compared the hemodynamic changes related to anesthesia induction with intravenous (IV)
propofol‐ and sevoflurane‐based inhalational induction in patients undergoing fiberoptic intubation for cervical spine surgery.
Material and Methods: A total of 72 patients were studied. Hemodynamic effects were assessed measuring mean arterial
pressure (MAP), and the echocardiographic evaluation of the left ventricular function. A Student’s t‐test with Bonferroni correction
or Chi‐squared test was used, when appropriate, to assess differences in hemodynamic (extent of MAP drop and incidence of
episodes of severe arterial hypotension) and other variables (occurrence and duration of episodes of apnea).
Results: Patients assigned to total IV anesthetic approach had a lower MAP, and more significant changes in cardiac function
compared to those who received the inhalational approach (68.1 ± 9.3 mmHg vs. 75.5 ± 10.3 mmHg; 25% vs. 5.5%).
Conclusion: Anesthesia induction with both propofol or sevoflurane is safe and effective. However, total IV anesthesia induction
is associated with more pronounced MAP drop which can worsen spinal cord hypoperfusion
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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