Brain Injury Biomarkers in Humans Undergoing General Anaesthesia and Noncerebral Surgery

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica Pub Date : 2025-08-23 DOI:10.1155/ane/7343075

Richard Vithal, Ali El-Merhi, Amar Chandan, Anna Kosovic, Helena Odenstedt Herges, Henrik Zetterberg, Christina Biörserud, Miroslaw Staron, Jaquette Liljencrantz, Linda Block

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Abstract

Introduction: This study is aimed at investigating brain injury biomarkers neurofilament light (NfL), tau, neuron-specific enolase (NSE), calcium-binding protein S100B (S100B) and glial fibrillary acidic protein (GFAP) in blood during general anaesthesia and abdominal surgery in patients without cerebral injury, to evaluate the effect of general anaesthesia and surgery per se on the release of these biomarkers.

Methods: This prospective observational study was conducted at Sahlgrenska University Hospital, Gothenburg, Sweden, between September and November 2021. Patients scheduled for mixed abdominal surgery under general anaesthesia were included. Vital parameters and near-infrared spectroscopy (NIRS) for cerebral perfusion were continuously monitored. Blood pressure was kept close to each patients’ preanaesthetic mean arterial pressure. Vasopressors and fluids were administered at the discretion of the attending physician, not influenced by the study.

Results: There were 23 patients (11 females [48%] and 12 males [52%]) included in the study. NfL, tau, NSE and S100B increased significantly when 2- and 24-h concentrations were compared with preoperative values, whilst GFAP did not. The continuous mean arterial blood pressure was 83.5 mmHg, with a 62.2–90.4 mmHg range. The mean NIRS was 77.5% (range 62.2–90.4). No patient had a drop in NIRS of 12% or more. Postoperative symptoms of confusion or neurological deficits were not observed in any patient within 48 h from the start of anaesthesia.

Conclusion: General anaesthesia and abdominal surgery in patients with well-maintained cerebral perfusion and no clinical signs of postoperative cerebral injury caused an increase in levels of brain injury biomarkers NfL, tau, NSE and S100B in blood. Interestingly, there was no increase in levels of GFAP in the blood. These data suggest that GFAP is the only biomarker, amongst the investigated biomarkers, which is not released into the bloodstream during general anaesthesia and surgery in patients with no suspected brain injury. More extensive studies on this subject are warranted.

Trial Registration: ClinicalTrials.gov identifier: NCT03919370.

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接受全身麻醉和非脑手术的人的脑损伤生物标志物

本研究旨在研究无脑损伤患者全身麻醉和腹部手术期间血液中脑损伤生物标志物神经丝光（NfL）、tau、神经元特异性烯醇化酶（NSE）、钙结合蛋白S100B （S100B）和胶质纤维酸性蛋白（GFAP）的变化，以评估全身麻醉和手术本身对这些生物标志物释放的影响。方法：这项前瞻性观察研究于2021年9月至11月在瑞典哥德堡Sahlgrenska大学医院进行。计划在全身麻醉下进行混合腹部手术的患者包括在内。连续监测脑灌注的生命参数和近红外光谱（NIRS）。血压与麻醉前平均动脉压保持接近。血管加压剂和液体由主治医生决定，不受研究的影响。结果：共纳入23例患者，其中女性11例[48%]，男性12例[52%]。与术前相比，2 h和24 h时，NfL、tau、NSE和S100B浓度显著升高，而GFAP则无显著升高。连续平均动脉血压为83.5 mmHg，范围为62.2-90.4 mmHg。平均近红外光谱为77.5%（62.2-90.4）。没有患者的近红外光谱下降12%或更多。术后48小时内未见任何患者出现精神错乱或神经功能缺损的症状。结论：在脑灌注维持良好且无术后脑损伤临床体征的患者中，全麻和腹部手术可导致血液中脑损伤生物标志物NfL、tau、NSE和S100B水平升高。有趣的是，血液中的GFAP水平没有增加。这些数据表明，GFAP是在所研究的生物标志物中唯一在全身麻醉和无疑似脑损伤患者手术期间不释放到血液中的生物标志物。有必要对这个问题进行更广泛的研究。试验注册：ClinicalTrials.gov标识符：NCT03919370。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurologica Scandinavica 医学-临床神经学

CiteScore

6.70

自引率

2.90%

发文量

161

审稿时长

4-8 weeks

期刊介绍： Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.