Citicoline in the prevention of postoperative cognitive dysfunction during total intravenous anesthesia

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Abstract

At present there is strong evidence of negative influence of general anesthesia on the brain, with the development of postoperative cognitive dysfunction (POCD). The lack of generally accepted approaches to medicamentous prevention of POCD raises the question of intraoperative cerebral protection. Forty female patients (aged 17–69 years) who underwent laparoscopic cholecystectomy under total intravenous anesthesia (TIVA) based on propofol and fentanyl were included in the randomized double-blind placebo-controlled study. Twenty patients were
randomly assigned to the main group and were given intraoperatively citicoline (Ceraxon, 1000 mg i.v.), and 20 patients received placebo. Hemodynamics, Harvard standard of patient’s safety, bispectral and perfusion indexes were intraoperatively monitored. Neuropsychological testing including tables of Schulte, the 10 words recall test and the Hospital Anxiety and Depression Scale (HADS) were performed preoperatively, as well as on day 1 and day 3 after surgery. Both groups were matched by demographics, coexisting pathology, preoperative cognitive status and anxiety. Anesthesia was adequate with equivalent demand of anesthetics in all patients. Post-anesthesia
recovery period parameters were significantly better in the treatment group compared to placebo (p<0.05). On day 1, POCD was detected in 20% of patients in the treatment group and in 50% in the placebo group (p<0.05). On day 3, improvement of long-term memory (by 56%) and attention (by 14.3%) was observed in the Ceraxon group comparing to placebo (p<0.05). HADS results on day 1 did not show any significant difference between the groups, but a positive trend of the decrease of anxiety in the treatment group was observed. Thus, Ceraxon used
intraoperatively does not influence on anesthetic consumption, significantly improves the course of postanesthetic recovery and prevents the development of POCD in the postoperative period

About the authors

A. M. Ovezov

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

M. A. Lobov

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Email: platonova@neurology.ru
Russian Federation

E. D. Nad’kina

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Email: platonova@neurology.ru
Russian Federation

P. S. Myatchin

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Email: platonova@neurology.ru
Russian Federation

M. V. Panteleeva

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Email: platonova@neurology.ru
Russian Federation

A. V. Knyazev

Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky

Email: platonova@neurology.ru
Russian Federation

References

  1. Большедворов Р.В., Кичин В.В., Федоров С.А., Лихванцев В.В. Эпидемиология послеоперационных когнитивных расстройств. Анестезиология и реаниматология 2009; 3: 20–24.
  2. Князев А.В., Пантелеева М.В. Неврологические осложнения у детей с врожденными пороками сердца в предоперационном, интраоперационном и постоперационном периодах. Альманах клинической медицины 2001; Т. IV: Актуальные вопросы практической неврологии: 254–259.
  3. Лобов М.А., Болевич С.Б., Гринько А.Н. и др. Церебральные и метаболические нарушения при оперативных вмешательствах под общим обезболиванием у детей // Альманах клинической медицины 2006; Т.VIII: 170-172.
  4. Федоров С.А., Большедворов Р.В., Лихванцев В.В. Причины ранних расстройств психики больного после операций, выполненных в условиях общей анестезии. Вестн. интенс. терапии 2007; 4: 17–25.
  5. Bedford P.D. Adverse cerebral effects of anaesthesia on old people. Lancet 1955; 269:259–263.
  6. Brambrink A.M., Evers A.S., Avidan M.S. et al. Isoflurane-induced Neuroapoptosis in the Neonatal Rhesus Macaque Brain. Anesthesiology 2010; 112: 834–841.
  7. Burkhart C.S. Can postoperative cognitive dysfunction be avoided? Hosp. Pract. (Minneap). 2012; 40: 214–223.
  8. Chong K.Y., Gelb A.W. Cerebrovascular and cerebral metabolic effects of commonly used anaesthetics. Acad. Med. Singapore 1994; 23: 145–149.
  9. Demeure M.J., Fain M.J. The elderly surgical patient and postoperative delirium. J. Am. Coll. Surg. 2006; 203: 752–757.
  10. Evered L., Scott D.A., Silbert B., Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth. Analg. 2011; 112: 1179–1185.
  11. Fioravanti M., Yanagi M. Cytidinediphosphocholine (CDPcholine) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst. Rev. 2005; 2: CD000269.
  12. Fodale V., Santamaria L.B. The inhibition of central nicotinic nAch receptors is the possible cause of prolonged cognitive impairment after anesthesia. Anesth. Analg. 2003; 97: 1207.
  13. Gilberstadt H., Aberwald R., Crosbie S. et al. Effect of surgery on psychological and social functioning in elderly patients. Arch. Intern. Med. 1968; 122:109–115.
  14. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. The European Stroke Organisation (ESO) Execute Committee and the ESO Writing Committee. Cerebrovasc. Dis. 2008; 25: 457–507.
  15. Jevtovic-Todorovic V., Hartman RE., Izumi Y. et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J. Neurosci. 2003; 23: 876–882.
  16. Johnson S.A., Young C., Olney J.W. Isoflurane-induced neuroapoptosis in the developing brain of non-hypoglycemic mice. J. Neurosurg. Anesth. 2008; 20: 21–28.
  17. Johnson T., Monk T., Rasmussen L.S. et al. ISPOCD2 Investigators. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology 2002; 96: 1351–1357.
  18. Levin E.D., Uemura E., Bowman R.E. Neurobehavioral toxicology of halothane in rats. Neurotoxicol. Teratol. 1991; 13: 461–470.
  19. Moller J.T., Cluitmans P., Rasmussen L.S. et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857–861.
  20. Monk T.G., Weldon B.C., Garvan C.W. et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008; 108: 18-30.
  21. Murkin J.M., Newman S.P., Stump D.A., Blumenthal J.A. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann. Thorac. Surg. 1995; 59: 1289–1295.
  22. Paule M.G., Li M., Allen R.R. et al. Ketamine anesthesia during the first week of life can cause long-lasting cognitive deficits in rhesus monkeys. Neurotoxicol. Teratol. 2011; 33: 220–230.
  23. Pratico C., Quattrone D., Lucanto T. et al. Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium. Med. Hypotheses 2005; 65: 972–982.
  24. Rasmussen L.S., Larsen K., Houx P. et al. ISPOCD group. The assessment of postoperative cognitive function. Acta Anaesth. Scand. 2001; 45: 275–289.
  25. Sauer A.M., Kalkman C., van Dijk D. Postoperative cognitive decline. J. Anesth. 2009; 23:256–259.
  26. Secades J.J. Citicoline: pharmacological and clinical review, 2010 update. Rev. Neurol. 2011; 52 (Suppl. 2): S1–S62.
  27. Slikker W.Jr., Zou X., Hotchkiss C.E. et al. Ketamine induced neuronal ьcell death in the perinatal rhesus monkey. Toxicol. Sci. 2007; 98: 145–158.
  28. Zhang X., Xue Z., Sun A. Subclinical concentration of sevoflurane potentiates neuronal apoptosis in the developing C57BL/6 mouse brain. Neurosci. Lett. 2008; 447: 109–114.

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Copyright (c) 2017 Ovezov A.M., Lobov M.A., Nad’kina E.D., Myatchin P.S., Panteleeva M.V., Knyazev A.V.

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