title: Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.
abstract: Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p<0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea.
authors.forename: Go Un
authors.initials: GU
authors.lastname: Roh
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: Won Oak
authors.initials: WO
authors.lastname: Kim
authors.affiliation: Department of Urology, Urological Science Institute and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Jeong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. Electronic address: nswksj@yuhs.ac.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply; D002560:Cerebrovascular Circulation; D003071:Cognition / Q000502:physiology*; D018475:Head-Down Tilt / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D015995:Prevalence; D011468:Prostatectomy / Q000379:methods*; D056910:Republic of Korea / Q000453:epidemiology; D065287:Robotic Surgical Procedures / Q000379:methods*; D014689:Venous Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*
keywords: Elderly; Internal jugular vein valve incompetence; Robotic surgery; postoperative cognitive dysfunction