Purpose Postoperative cognitive dysfunction is a frequent complication occurring in geriatric patients. Type of anesthesia and the patient's inflammatory response may contribute to postoperative cognitive dysfunction (POCD). In this prospective randomized double-blinded controlled study we hypothesized that intraoperative remifentanil may reduce immediate and early POCD compared to fentanyl and evaluated if there is a correlation between cognitive status and postoperative inflammatory cytokines level. Methods Six hundred twenty-two patients older than 60 years undergoing major abdominal surgery were randomly assigned to two groups and treated with different opioids during surgery: continuous infusion of remifentanil or fentanyl boluses. Twenty-five patients per group were randomly selected for the quantitative determination of serum interleukin (IL)-1β, IL-6, and IL-10 to return to the ward and to the seventh postoperative day. Results Cognitive status and its correlation with cytokines levels were assessed. The groups were comparable regarding to POCD incidence; however, IL-6 levels were lower the seventh day after surgery for remifentanil group (P= .04). No correlation was found between POCD and cytokine levels. Conclusions The use of remifentanil does not reduce POCD.

De Cosmo, G., Sessa, F., Fiorini, F., Congedo, E., Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery, <<JOURNAL OF CLINICAL ANESTHESIA>>, 2016; 35 (Dec): 40-46. [doi:10.1016/j.jclinane.2016.07.016] [http://hdl.handle.net/10807/91754]

Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery

De Cosmo, Germano
;
Sessa, Flaminio
Secondo
;
Fiorini, Federico
Penultimo
;
Congedo, Elisabetta
Ultimo
2016

Abstract

Purpose Postoperative cognitive dysfunction is a frequent complication occurring in geriatric patients. Type of anesthesia and the patient's inflammatory response may contribute to postoperative cognitive dysfunction (POCD). In this prospective randomized double-blinded controlled study we hypothesized that intraoperative remifentanil may reduce immediate and early POCD compared to fentanyl and evaluated if there is a correlation between cognitive status and postoperative inflammatory cytokines level. Methods Six hundred twenty-two patients older than 60 years undergoing major abdominal surgery were randomly assigned to two groups and treated with different opioids during surgery: continuous infusion of remifentanil or fentanyl boluses. Twenty-five patients per group were randomly selected for the quantitative determination of serum interleukin (IL)-1β, IL-6, and IL-10 to return to the ward and to the seventh postoperative day. Results Cognitive status and its correlation with cytokines levels were assessed. The groups were comparable regarding to POCD incidence; however, IL-6 levels were lower the seventh day after surgery for remifentanil group (P= .04). No correlation was found between POCD and cytokine levels. Conclusions The use of remifentanil does not reduce POCD.
Inglese
De Cosmo, G., Sessa, F., Fiorini, F., Congedo, E., Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery, <<JOURNAL OF CLINICAL ANESTHESIA>>, 2016; 35 (Dec): 40-46. [doi:10.1016/j.jclinane.2016.07.016] [http://hdl.handle.net/10807/91754]
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