Trastorno neurocognitivo postoperatorio: una revisión de aspectos básicos.
Barra lateral del artículo
Publicado:
dic 27, 2021
Palabras clave:
Disfunción cognitiva, cuidados posoperatorios, periodo posoperatorio, cirugía
Contenido principal del artículo
Resumen
El trastorno neurocognitivo posoperatorio es una condición conocida desde hace varias décadas que se caracteriza por alteración de la atención, lenguaje, función perceptiva, la función motora, la memoria y el aprendizaje que se relaciona con el acto quirúrgico y el uso de anestesia. Sin embargo, no existe definición estandarizada del trastorno, así como tampoco hay delimitación de los criterios para el diagnostico. Esta disfunción es usualmente transitoria y puede llegar a persistir por varios años; en términos generales, afecta principalmente a adultos mayores que son sometidos a tiempos quirúrgicos prolongados. Los manuscritos actuales mencionan que se debe diagnosticar usando pruebas estandarizadas para evaluar deterioro cognitivo antes y después del procedimeinto quirúrgico, haciendo por lo menos un seguimiento dentro del primer año del posoperatorio.
En cuanto al tratamiento, se han sugerido fármacos que actúan sobre las vías propuestas como mecanismos fisiopatológicos, dentro de los cuales destacan los analgésicos y los antioxidantes.
Detalles del artículo
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1.
Picón Jaimes YA, Lara-Ortega R, Padilla-Zambrano H, Ramos-Villegas Y, Quintana-Pájaro L, Andrade-López A, et al. Trastorno neurocognitivo postoperatorio: una revisión de aspectos básicos. . Rev Arg de Ter Int. [Internet]. 27 de diciembre de 2021 [citado 28 de diciembre de 2024];38. Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/788
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La revista no retiene los derechos de reproducción (copyright) por lo que los autores pueden volver a publicar sus trabajos con la sola mención a la fuente original de publicación.
Citas
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25. Zhu Y-Z, Yao R, Zhang Z, Xu H, Wang L-W. Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty: A double-blind, randomized clinical consort study. Medicine (Baltimore). 2016;95(28):e4082.
26. Zhu Y, Yao R, Li Y, Wu C, Heng L, Zhou M, et al. Protective effect of celecoxib on early postoperative cognitive dysfunction in geriatric patients. Front Neurol. 2018;9:633.
27. Karaman T, Karaman S, Doğru S, Tapar H, Şahin A, Süren M. Short-term and long-term effects of dexamethasone on cognitive dysfunction induced by sevoflurane in adult rats. Turk J Anaesthesiol Reanim. 2017;45(3):158–63.
28. Valentin LS, Pereira VF, Pietrobon RS, Schmidt AP, Oses JP, Portela LV, et al. Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction-A phase III double blind, randomized clinical trial. PLoS One. 2016;11(5):e0152308.
29. Cerqueira N, Oliveira EF, Gesto DS, Santos-Martins D, Moreira C, Moorthy HN, et al. Cholesterol biosynthesis: A mechanistic overview. Biochemistry. 2016;55(39):5483–506.
2. Tire Y, Aydoğan E, Sargın M, Kozanhan B. Assessment of postoperative cognitive dysfunction: Results from a survey of Turkish anaesthesiologists. Turk J Anaesthesiol Reanim. 2020;48(4):300–7.
3. Hollinger A, Rüst CA, Riegger H, Gysi B, Tran F, Brügger J, et al. Ketamine vs. haloperidol for prevention of cognitive dysfunction and postoperative delirium: A phase IV multicentre randomised placebo-controlled double-blind clinical trial. J Clin Anesth. 2021;68(110099):110099.
4. Ackenbom MF, Butters MA, Davis EM, Abebe KZ, Baranski L, Zyczynski HM. Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery. Int Urogynecol J. 2021;32(2):433–42.
5. Needham MJ, Webb CE, Bryden DC. Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth. 2017;119:i115–25.
6. Paredes S, Cortínez L, Contreras V, Silbert B. Disfunción cognitiva postoperatoria a los 3 meses en adultos después de cirugía no cardíaca: una revisión sistemática cualitativa. Acta Anaesthesiol Scand. 2016; 60: 1043–1058.
7. Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand. 2000;44:1246–1251.
8. Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery. Anesth Analg. 2018;127(2):496–505.
9. Kotekar N, Shenkar A, Nagaraj R. Postoperative cognitive dysfunction - current preventive strategies. Clin Interv Aging. 2018;13:2267–73.
10. Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive reserve and the risk of postoperative cognitive dysfunction. Dtsch Arztebl Int. 2017;114(7):110–7.
11. Lin X, Chen Y, Zhang P, Chen G, Zhou Y, Yu X. The potential mechanism of postoperative cognitive dysfunction in older people. Exp Gerontol. 2020;130(110791):110791.
12. Liu Y, Yin Y. Emerging roles of immune cells in postoperative cognitive dysfunction. Mediators Inflamm. 2018;2018:1–8.
13. Safavynia SA, Goldstein PA. The role of neuroinflammation in postoperative cognitive dysfunction: Moving from hypothesis to treatment. Front Psychiatry. 2018;9:752.
14. Zhang T, Leng Z, Liu W, Wang X, Yan X, Yu L. Suppressed expression of mitogen-activated protein kinases in hyperthermia induced defective neural tube. Neurosci Lett. (2015) 594:6–11. 10.1016/j.neulet.2015.03.046
15. Kapoor I, Prabhakar H, Mahajan C. Postoperative cognitive dysfunction. Indian J Crit Care Med. 2019;23(Suppl 2):S162–4.
16. Orhun G, Sungur Z, Koltka K, Savran Karadeniz M, Yavru HA, Gürvit H, et al. Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulus Travma Acil Cerrahi Derg. 2020;26(1):30–6.
17. Gao Y, Liu L, Zhao B, Wang Y, Yu S, Wang H. Effect of general and non-general anesthesia on postoperative cognitive dysfunction. J Coll Physicians Surg Pak. 2020;30(4):407–11
18. Pappa M, Theodosiadis N, Tsounis A, Sarafis P. Pathogenesis and treatment of post-operative cognitive dysfunction. Electron Physician. 2017;9(2):3768–75.
19. Sturm H, Wildermuth R, Stolz R, Bertram L, Eschweiler GW, Thomas C, et al. Diverging awareness of postoperative delirium and cognitive dysfunction in German health care providers. Clin Interv Aging. 2019;14:2125–35
20. Devinney MJ, Mathew JP, Berger M. Postoperative delirium and postoperative cognitive dysfunction: Two sides of the same coin? Anesthesiology. 2018;129(3):389–91.
21. Borchers F, Spies CD, Feinkohl I, Brockhaus W-R, Kraft A, Kozma P, et al. Methodology of measuring postoperative cognitive dysfunction: a systematic review. Br J Anaesth. 2021;126(6):1119–27.
22. Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59(5):1289–95.
23. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth. 2018;121(5):1005–12.
24. Peng M, Wang Y-L, Wang F-F, Chen C, Wang C-Y. The cyclooxygenase-2 inhibitor parecoxib inhibits surgery-induced proinflammatory cytokine expression in the hippocampus in aged rats. J Surg Res. 2012;178(1):e1-8.
25. Zhu Y-Z, Yao R, Zhang Z, Xu H, Wang L-W. Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty: A double-blind, randomized clinical consort study. Medicine (Baltimore). 2016;95(28):e4082.
26. Zhu Y, Yao R, Li Y, Wu C, Heng L, Zhou M, et al. Protective effect of celecoxib on early postoperative cognitive dysfunction in geriatric patients. Front Neurol. 2018;9:633.
27. Karaman T, Karaman S, Doğru S, Tapar H, Şahin A, Süren M. Short-term and long-term effects of dexamethasone on cognitive dysfunction induced by sevoflurane in adult rats. Turk J Anaesthesiol Reanim. 2017;45(3):158–63.
28. Valentin LS, Pereira VF, Pietrobon RS, Schmidt AP, Oses JP, Portela LV, et al. Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction-A phase III double blind, randomized clinical trial. PLoS One. 2016;11(5):e0152308.
29. Cerqueira N, Oliveira EF, Gesto DS, Santos-Martins D, Moreira C, Moorthy HN, et al. Cholesterol biosynthesis: A mechanistic overview. Biochemistry. 2016;55(39):5483–506.