Relationship between Depth of Anesthesia and Interleukin-6 with the Incidence of Postoperative Delirium (POD) in Geriatric Patients Undergoing General Anesthesia
-
Natalina Manalu
,
Syafruddin Gaus
,
Syamsul Hilal Salam
,
Andi Salahuddin
,
Muhammad Rum
,
Madonna Damaynthie Datu
Abstract
Background: The incidence of postoperative delirium (POD) in geriatric patients is aged 3-61%. The combined effects of inflammatory factors and depth of anesthesia can affect neurotransmitters and receptors in the central nervous system that affect POD. To analyze the relationship between depth of anesthesia and IL-6 with the incidence of POD in geriatric patients undergoing general anesthesia.
Methods: A prospective cohort study was conducted in geriatric patients undergoing general anesthesia. Patients were divided into two groups based on the bispectral index (BIS): BIS 40-45 and BIS 51-60. POD was measured using the Confusion Assessment Method (CAM) and Mini-Mental State Exam (MMSE) 24 hours postoperatively. Serum IL-6 measurements were also performed before and 24 hours postoperatively.
Results: A total of 22 patients were collected with the results that the MMSE score decreased insignificantly at 24 hours postoperatively, and there was no difference in MMSE scores based on BIS (p > 0.05). The depth of anesthesia was significantly associated with CAM (p < 0.05). Delirium incidence was more frequent in BIS 40-45. IL-6 levels increased significantly at 24 hours postoperatively (p < 0.05). IL-6 levels were not significantly associated with MMSE and CAM scores (p > 0.05).
Conclusion: BIS 40-45 has the potential to be a predictor of POD in geriatric patients with general anesthesia.
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[26] Lv A qing, Huang L cai, Lao W long, Song Q liang, Zhou Q fu, Jiang Z ming, et al. Effects of different depth of anesthesia on perioperative inflammatory reaction and hospital outcomes in elderly patients undergoing laparoscopic radical gastrectomy. BMC Anesthesiol. 2022; 22(1): 1–6.
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[2] Mohamed EES, Elfeky EE, Abd_Elrahman AI, Gendy AS. The effect of general anesthesia on geriatric patients’ cognitive function. Menoufia Med J. 2020; 33: 346–50.
[3] Li R, Zhang Y, Zhu Q, Wu Y, Song W. The role of anesthesia in peri_operative neurocognitive disorders: Molecular mechanisms and preventive strategies. Fundam Res. 2023; 4(4): 797–805.
[4] Gong M, Wang G, Li G, Liu J, Sun P, Xu L, et al. Dysfunction of inflammation-resolving pathways is associated with postoperative cognitive decline in elderly mice. Behav Brain Res. 2020; 386(12): 112538.
[5] Wu Y, Yu C, Gao F. Risk factors for postoperative cognitive dysfunction in elderly patients undergoing surgery for oral malignancies. Perioper Med. 2023; 12(1): 1–9.
[6] Janoutová J, Šerý O, Hosák L, Janout V. Is mild cognitive impairment a precursor of alzheimer’s disease? Short review. Cent Eur J Public Health. 2015; 23(4): 365–7.
[7] Ling L, Yang TX, Lee SWK. Effect of anaesthesia depth on postoperative delirium and postoperative cognitive dysfunction in high-risk patients: a systematic review and meta-analysis. Cureus. 2022; 14(10).
[8] Shu AH, Wang Q, Chen XB. Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial. Curr Med Res Opin. 2015; 31(10): 1883–7.
[9] Li Z, Zhu Y, Kang Y, Qin S, Chai J. Neuroinflammation as the underlying mechanism of postoperative cognitive dysfunction and therapeutic strategies. Front Cell Neurosci. 2022; 16(3): 1–16.
[10] Wan Y, Xu J, Ma D, Zeng Y, Cibelli M, Maze M. Postoperative impairment of cognitive function in rats. Anesthesiology. 2007; 106(3): 436–43.
[11] Quan C, Chen J, Luo Y, Zhou L, He X, Liao Y, et al. BIS-guided deep anesthesia decreases short-term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav. 2019; 9(4): 1–10.
[12] Lu X, Jin X, Yang S, Xia Y. The correlation of the depth of anesthesia and postoperative cognitive impairment: A meta-analysis based on randomized controlled trials. J Clin Anesth. 2018; 45: 55–9.
[13] Nania M, Gupta A, Saha U, Mobing H, Saini S. Postoperative Cognitive Dysfunction in Patients Undergoing Surgery under Monitored Anaesthesia Care. IOSR J Dent Med Sci. 2023; 22(3): 55–62.
[14] Lee KH, Kim JY, Kim JW, Park JS, Lee KW, Jeon SY. Influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients. Anesthesiol Pain Med. 2015; 5(5).
[15] Evered LA, Chan MTV, Han R, Chu MHM, Cheng BP, Scott DA, et al. Anaesthetic depth and delirium after major surgery: a randomised clinical trial. Br J Anaesth. 2021; 127(5): 704–12.
[16] Long Y, Feng X, Liu H, Shan X, Ji F, Peng K. Effects of anesthetic depth on postoperative pain and delirium: A meta-analysis of randomized controlled trials with trial sequential analysis. Chin Med J (Engl). 2022; 135(23): 2805–14.
[17] Liebert AD, Chow RT, Bicknell BT, Varigos E. Neuroprotective effects against POCD by photobiomodulation: Evidence from assembly/disassembly of the cytoskeleton. J Exp Neurosci. 2016; 10(1): 1–19.
[18] Lu B, Yuan H, Zhai X, Li X, Qin J, Chen J, et al. High-Pressure Pneumoperitoneum Aggravates Surgery-Induced Neuroinflammation and Cognitive Dysfunction in Aged Mice. Mediators Inflamm. 2020; 2020.
[19] Feng X, Valdearcos M, Uchida Y, Lutrin D, Maze M, Koliwad SK. Microglia mediate postoperative hippocampal inflammation and cognitive decline in mice. JCI Insight. 2017; 2(7).
[20] Kristek G, Radoš I, Kristek D, Kapural L, Nešković N, Škiljić S, et al. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: A randomized controlled trial. Reg Anesth Pain Med. 2019; 44(1): 59–68.
[21] Zhao Y, Huang L, Xu H, Wu G, Zhu M, Tian J, et al. Neuroinflammation Induced by Surgery Does Not Impair the Reference Memory of Young Adult Mice. Mediators Inflamm. 2016; 2016.
[22] Sharipova V, Alimov A, Valihanov A. Interleukin-6 and glial fibrillary acidic protein in prediction of early postoperative cognitive dysfunction after orthopedic surgery. Clin Med Diagnostics. 2020; 10(2): 38–42.
[23] Zhang S, Tao X jun, Ding S, Feng X wei, Wu F qin, Wu Y. Associations between postoperative cognitive dysfunction, serum interleukin-6 and postoperative delirium among patients after coronary artery bypass grafting: A mediation analysis. Nurs Crit Care. 2024; 29(6): 1245–52.
[24] Chen Y, Lu S, Wu Y, Shen Y, Zhao H, Ding S, et al. Change in serum level of interleukin 6 and delirium after coronary artery bypass graft. Cardiovasc Crit Care. 2019; 28(6): 462–70.
[25] Li H, Li J, Hao C, Luan H, Zhang X, Zhao Z. Effects of anesthetic depth on perioperative T lymphocyte subsets in patients undergoing laparoscopic colorectal cancer surgery: a prospective, parallel-controlled randomized trial. BMC Anesthesiol. 2023; 23(1): 1–10.
[26] Lv A qing, Huang L cai, Lao W long, Song Q liang, Zhou Q fu, Jiang Z ming, et al. Effects of different depth of anesthesia on perioperative inflammatory reaction and hospital outcomes in elderly patients undergoing laparoscopic radical gastrectomy. BMC Anesthesiol. 2022; 22(1): 1–6.
[27] Hou R, Wang H, Chen L, Qiu Y, Li S. POCD in patients receiving total knee replacement under deep vs light anesthesia: A randomized controlled trial. Brain Behav. 2018; 8(2): 1–6.
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How to Cite
1.
Manalu N, Gaus S, Salam S, Salahuddin A, Rum M, Datu M. Relationship between Depth of Anesthesia and Interleukin-6 with the Incidence of Postoperative Delirium (POD) in Geriatric Patients Undergoing General Anesthesia. Arch Anesth & Crit Care. 2025;.
