European journal of anaesthesiology
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Randomized Controlled Trial
The effects of cognitive impairment on anaesthetic requirement in the elderly.
Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls. ⋯ The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment.
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Randomized Controlled Trial Comparative Study
Comparison of Bullard and Airtraq laryngoscopes with conventional laryngoscopy in a manikin study of simulated difficult intubation.
When airway management is difficult, various measures can be taken to facilitate tracheal intubation. The Bullard and Airtraq laryngoscopes were developed for this purpose. We hypothesised that the Bullard and Airtraq laryngoscopes would perform better than a conventional laryngoscope in the management of a simulated difficult airway. We also hypothesised that the indirect laryngoscopes would perform comparably. ⋯ In a moderately difficult airway scenario, all laryngoscopes performed equally well. However, in a more difficult airway scenario, the Bullard and Airtraq laryngoscopes performed better than the conventional laryngoscope, with the Bullard device performing better than the Airtraq. This may be in part related to differing prior experiences of operators with the respective airway devices.
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Assessment of Mallampati class is an integral part of preoperative airway evaluation. Increasing Mallampati class is known to be associated with greater difficulty with intubation, but some cases of airway difficulty in Mallampati 'class zero' patients have been reported. ⋯ A Mallampati class zero per se is not associated with difficult airway unless other airway characteristics contribute to the difficulty. Even though the epiglottis may be large and overhanging, it rarely causes airway difficulty in Mallampati class zero airway.
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Preoperative cognitive impairment (PreCI), amnesic mild cognitive impairment (aMCI; a risk factor for Alzheimer's disease) and multiple domain MCI with amnesia (mdMCI+a) identify preoperative cognitive abnormalities in patients scheduled for coronary artery bypass graft surgery (CABG). ⋯ PreCI, aMCI and mdMCI+a identified preoperative cognitive abnormalities in different groups of patients scheduled for CABG surgery. The findings emphasise that identification of patients with preoperative cognitive dysfunction is methodology-dependent. The optimal approach to subsequently identify patients who may be at greatest risk of progressive cognitive deterioration after CABG surgery remains to be determined.
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Surgery-induced neuroinflammation has been implicated in the development of postoperative cognitive dysfunction (POCD). ⋯ These findings suggest that COX-2-dependent mechanisms may play a role in the development of POCD. This effect may be dependent on the modulation of glial cell activation.