{"title":"认知障碍老年人对丙泊酚敏感性的潜在增加:一项对照双盲研究","authors":"Huiting Zhuge, Yu Zhou, Yimin Qiu, Xiaojing Huang","doi":"10.3389/fnagi.2024.1410181","DOIUrl":null,"url":null,"abstract":"BackgroundCognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients.MethodsSixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA &lt;26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55–65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed.ResultsBIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, <jats:italic>p</jats:italic> = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, <jats:italic>p</jats:italic> = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups.ConclusionCompared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly.","PeriodicalId":12450,"journal":{"name":"Frontiers in Aging Neuroscience","volume":null,"pages":null},"PeriodicalIF":4.1000,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study\",\"authors\":\"Huiting Zhuge, Yu Zhou, Yimin Qiu, Xiaojing Huang\",\"doi\":\"10.3389/fnagi.2024.1410181\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BackgroundCognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients.MethodsSixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA &lt;26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55–65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed.ResultsBIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, <jats:italic>p</jats:italic> = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, <jats:italic>p</jats:italic> = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups.ConclusionCompared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly.\",\"PeriodicalId\":12450,\"journal\":{\"name\":\"Frontiers in Aging Neuroscience\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2024-07-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Aging Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fnagi.2024.1410181\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Aging Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fnagi.2024.1410181","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景老年人的认知障碍可能会导致其对针对认知相关受体的麻醉剂的敏感性增加。本研究旨在探讨认知状态对老年患者手术期间异丙酚用量的影响。方法将计划进行腹腔镜前列腺癌根治术的 60 名老年患者分配到认知正常组(CogN,蒙特利尔认知评估(MoCA)评分≥26 分)或认知受损组(CogI,MoCA <26 分)。手术期间通过目标控制输注丙泊酚,使双频谱指数(BIS)保持在 55-65 之间。在三个时间点记录丙泊酚的消耗量:T1(睫毛反射消失)、T2(BIS = 50)、T3(拔管)。还记录了睫毛反射消失时的 BIS 值。结果 CogN 组和 CogI 组诱导前的 BIS 值相似。然而,在睫毛反射消失时,CogI 组的 BIS 值明显高于 CogN 组(平均值±标准差:65.3 ± 7.2 vs. 61.1 ± 6.8,p = 0.031)。CogI 与 CogN 相比,达到 BIS 50 所需的丙泊酚更低(1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg,p = 0.003)。结论与认知功能完整的老人相比,认知障碍老人在睫毛反射消失时表现出更高的BIS,并且需要更低的异丙酚剂量才能达到相同的BIS水平,这表明异丙酚的敏感性增加。认知状况可能会影响老年人对麻醉药物的需求。
Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study
BackgroundCognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients.MethodsSixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA <26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55–65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed.ResultsBIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, p = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, p = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups.ConclusionCompared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly.
期刊介绍:
Frontiers in Aging Neuroscience is a leading journal in its field, publishing rigorously peer-reviewed research that advances our understanding of the mechanisms of Central Nervous System aging and age-related neural diseases. Specialty Chief Editor Thomas Wisniewski at the New York University School of Medicine is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.