Objective

Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC).

Methods

We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC.

Results

A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42–1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [−0.29–0.67], P = 0.59).

Conclusions

Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.

中文翻译：

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未破裂颅内动脉瘤血管内治疗后的术后认知功能障碍：一项初步研究

客观的

术后认知功能障碍（POCD）在大手术后被广泛观察到，特别是在全身麻醉（GA）的老年患者中。然而，一个尚未解答的具体问题是，不同的麻醉管理方法是否与未破裂颅内动脉瘤（UIA）血管内治疗后不同的认知结果相关。本研究的目的是评估 POCD 与 GA 与监测麻醉护理 (MAC) 的相关性。

方法

我们进行了一项务实的前瞻性研究来评估不同麻醉方法与 POCD 之间的关联。我们比较了接受各种血管内方法（使用 GA 或 MAC）UIA 治疗的认知正常患者的术前和术后蒙特利尔认知评估 (MoCA) 评分。

结果

共有 23 名 UIA 患者参与了该研究。GA 或 MAC 下分别治疗了 7 例 (30.4%) 和 16 例 (69.6%) UIA，未出现围手术期并发症。GA 下术后 MoCA 评分显着下降（平均差 = 1.14；95% 置信区间 = [0.42–1.87]，P  < 0.01）。相比之下，MAC 下术前和术后 MoCA 评分没有显着差异（平均差 = 0.19；95% 置信区间 = [−0.29–0.67]，P = 0.59）。

结论

对于接受血管内治疗且认知能力正常的 UIA 的患者，与 GA 相比，使用 MAC 治疗 UIA 与 POCD 降低相关。需要更大规模的随机研究来证实这些发现。