title: Perioperative plasma concentrations of stable nitric oxide products are predictive of cognitive dysfunction after laparoscopic cholecystectomy.
abstract: In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100beta protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I-II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100beta protein and plasma concentrations of stable NO products (nitrate/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100beta protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100beta) are associated with early POCD. The former represents a potential biochemical predictor of POCD.
authors.affiliation: Departments of *Anaesthesia and Intensive Care Medicine and †Clinical Biochemistry, Cork University Hospital, Cork, Ireland.
authors.forename: G
authors.initials: G
authors.lastname: Iohom
authors.forename: S
authors.initials: S
authors.lastname: Szarvas
authors.forename: V
authors.initials: V
authors.lastname: Larney
authors.forename: J
authors.initials: J
authors.lastname: O'Brien
authors.forename: E
authors.initials: E
authors.lastname: Buckley
authors.forename: M
authors.initials: M
authors.lastname: Butler
authors.forename: G
authors.initials: G
authors.lastname: Shorten
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D015415:Biomarkers; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000187:drug effects; D008738:Methyl Ethers; D008875:Middle Aged; D009414:Nerve Growth Factors; D009483:Neuropsychological Tests; D009569:Nitric Oxide / Q000097:blood*; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000187:drug effects; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D000077149:Sevoflurane; D013060:Speech / Q000187:drug effects; D014665:Vasodilator Agents / Q000097:blood*
chemical_list: D018685:Anesthetics, Inhalation; D015415:Biomarkers; D008738:Methyl Ethers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D014665:Vasodilator Agents; D009569:Nitric Oxide; D000077149:Sevoflurane