Department of Neurosurgery, 21782University of Iowa Hospitals and Clinics, USA.
Department of Neurology, 21782University of Iowa Hospitals and Clinics, USA.
Interv Neuroradiol. 2022 Aug;28(4):439-443. doi: 10.1177/15910199211039917. Epub 2021 Sep 13.
Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC).
We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC.
A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42-1.87], < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [-0.29-0.67], = 0.59).
Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.
术后认知功能障碍（POCD）在大手术后广泛观察到，尤其是在接受全身麻醉（GA）的老年患者中。然而，一个未得到解答的具体问题是，不同的麻醉管理方法是否与未破裂颅内动脉瘤（UIAs）血管内治疗后的不同认知结果相关。本研究的目的是评估 POCD 与 GA 与监测麻醉护理（MAC）的相关性。
我们进行了一项实用的前瞻性研究，以评估不同麻醉方法与 POCD 之间的关系。我们比较了接受各种血管内方法治疗 UIAs 的认知正常患者在 GA 或 MAC 下的手术前后蒙特利尔认知评估（MoCA）评分。
共有 23 例 UIAs 患者入组研究。7 例（30.4%）和 16 例（69.6%）UIAs 在 GA 或 MAC 下分别无围手术期并发症得到治疗。GA 下术后 MoCA 评分显著下降（平均差异 = 1.14；95%置信区间 = [0.42-1.87]， < 0.01）。相比之下，MAC 下术前和术后 MoCA 评分无显著差异（平均差异 = 0.19；95%置信区间 = [-0.29-0.67]， = 0.59）。
与 GA 相比，MAC 治疗认知正常患者的 UIAs 与血管内治疗后 POCD 下降相关。需要更大规模的随机研究来证实这些发现。
