Effects of Total Intravenous Anesthesia and Static Aspiration Combined General Anesthesia on Postoperative Cognitive Function and Psychological State of Elderly Patients with Esophageal Cancer

Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.

Cognitive function correlations with apolipoprotein Eε4 single nucleotide polymorphism in 1000 elderly patients following general anesthesia A randomized controlled study

BACKGROUND： Cognitive dysfunction occurs in elderly patients following general anesthesia, and this might be associated with genetics. Studies have shown that the ε4 allele gene is closely associated with senile dementia. OBJECTIVE： To compare and analyze the correlations between cognitive dysfunction and single nucleotide polymorphism of apolipoprotein E （ApoE） following inhalation or intravenous anesthesia. DESIGN, TIME AND SETTING： A randomized, controlled study was performed. The patients were recruited from the Department of Anesthesia, Second Affiliated Hospital, Medical College, Xi＇an Jiaotong University, China between May 2005 and December 2008. Genetic analyses were conducted at the Departments of Neuroanatomy and Forensic Medicine, Medical Corlege, Xi＇an Jiaotong University, China. PARTICIPANTS： A total of t 000 patients of ASA I-II grade, without genetic connection, were enrolled in this study, comprising 520 males and 480 females, aged （70.1± 4.6） years and weighing （57.3 ± 7.5） kg. No patients suffered from cognitive dysfunction. METHODS： The patients were equally and randomly divided into intravenous anesthesia and gas anesthesia groups. Total intravenous anesthesia and inhaled anesthesia were used. Genomic DNA from whole blood was extracted. The ApoE gene was amplified by PCR. Restriction fragment length polymorphism of ApoE gene was analyzed. Cognitive function was evaluated by Mini-Mental State Examination （MMSE）. Patients scoring 〈 25 points were diagnosed with cognitive dysfunction. MAIN OUTCOME MEASURES： Correlation of ApoE gene frequency and ApoE ε 4 allele to MMSE scores was measured. RESULTS： MMSE scores in patients from the gas anesthesia group significantly decreased 3 days after surgery, compared with the intravenous anesthesia group. The proportion of patients that scored 〈 25 points was significantly greater in the gas anesthesia group compared with the intravenous anesthesia group 3 days after surgery. Reduced MMSE scores closely correlated with expression of the ApoE ε 4 allele in the gas anesthesia group （odds ratio = 2.83; 95% confidence interval was 1.25-6.39, P 〈 0.05）. However, decreased MMSE scores did not closely correlated with expression of the ApoE ε 4 allele in the intravenous anesthesia group （odds ratio = 0.96; 95% confidence interval was 0.37-2.39, P 〉 0.05）. CONCLUSION： Results demonstrated a correlation between cognitive dysfunction and ApoE single nucleotide polymorphism in elderly patients after gas anesthesia. However, no relationship between cognitive dysfunction and ApoE single nucleotide polymorphism was determined in elderly patients following intravenous anesthesia. Therefore, elderly patients, especially those expressing the ApoE ε4 gene, should be cautiously exposed to gas anesthesia.

Application value of dexmedetomidine in anesthesia for elderly patients undergoing radical colon cancer surgery

BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.

综合性医院住院老年人认知功能的调查研究

分析综合性医院老年病人认知功能异常的检出率、特点及其影响因素。方法 :取 1997年 1月 15日上海甘泉医院住院病人 (年龄≥ 6 0岁 ) 16 4例。调查工具为中文版简易智能状态检查 (MMSE)。根据MMSE评分划分为正常组和异常组。结果 :①性别、教育程度对正常组与异常组MMSE均有影响 ;二组与教育程度密切有关 ,高文化程度对语言的短时记忆、物体命名有一定保护作用 ;但正常组随年龄增高 ,分数呈降低趋势 ,异常组MMSE总分、因子分则与年龄无相关 ;异常组受性别影响程度高于正常组 ,呈负相关。②认知功能异常检出率为 14 0 %。结论 :对 6 0岁以上住院病人进行常规认知功能筛选 。