Pérdida de memoria, enfermedad de Alzheimer y anestesia general. Una preocupación preoperatoria
Memory Loss, Alzheimer's Disease and General Anesthesia: A Preoperative Concern.
Thaler A, Siry R, Cai L, García PS, Chen L, Liu R.
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, USA.
J Anesth Clin Res. 2012 Feb 20;3(2). pii: 1000192.
Abstract
BACKGROUND:The long-term cognitive effects of general anesthesia are under intense scrutiny. Here we present 5 cases from 2 academic institutions to analyze some common features where the patient's or the patient family member has made a request to address their concern on memory loss, Alzheimer's disease and general anesthesia before surgery. METHODS:Records of anesthesia consultation separate from standard preoperative evaluation were retrieved to identify consultations related to memory loss and Alzheimer's disease from the patient and/or patient family members. The identified cases were extensively reviewed for features in common. We used Google® (http://www. google.com/) to identify available online information using "anesthesia memory loss" as a search phrase. RESULTS: Five cases were collected as a specific preoperative consultation related to memory loss, Alzheimer's disease and general anesthesiafrom two institutions. All of the individuals either had perceived memory impairment after a prior surgical procedure with general anesthesia or had a family member with Alzheimer's disease. They all accessed public media sources to find articles related to anesthesia and memory loss. On May 2nd, 2011, searching "anesthesia memory loss" in Google yielded 764,000 hits. Only 3 of the 50 Google top hits were from peer-reviewed journals. Some of the lay media postings made a causal association between general anesthesia and memory loss and/or Alzheimer's disease without conclusive scientific literature support. CONCLUSION: The potential link between memory loss and Alzheimer's disease with general anesthesia is an important preoperative concern from patients and their family members. This concern arises from individuals who have had history of cognitive impairment or have had a family member with Alzheimer disease and have tried to obtain information from public media. Proper preoperative consultation with the awareness of the lay literature can be useful in reducing patient and patient family member's preoperative anxiety related to this concern.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708317/pdf/nihms-387114.pdf
Exposición a la anestesia general y riesgo de enfermedad de Alzheimer. Revisión sistemática y meta-análisis
Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis.
Seitz DP, Shah PS, Herrmann N, Beyene J, Siddiqui N.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. seitzd@providencecare.ca
BMC Geriatr. 2011 Dec 14;11:83. doi: 10.1186/1471-2318-11-83.
Abstract
BACKGROUND:Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. METHODS: We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. RESULTS: A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. CONCLUSIONS: A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258207/pdf/1471-2318-11-83.pdf
Modulación anestésica de la neuroinflamación en la enfermedad de Alzheimer
Anesthetic modulation of neuroinflammation in Alzheimer's disease.
Tang JX, Eckenhoff MF, Eckenhoff RG.
Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Anaesthesiol. 2011 Aug;24(4):389-94. doi: 10.1097/ACO.0b013e32834871c5.
Abstract
PURPOSE OF REVIEW: To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. RECENT FINDINGS: A large and growing body of evidence shows that neuroinflammation participates in the development of neurodegeneration associated with Alzheimer's disease. Modulation may be possible early in the pathogenesis, and less so when cognitive symptoms appear. A dysfunctional hypoinflammatory response may permit accelerated damage due to other mechanisms in late disease. The peripheral inflammatory response elicited by surgery itself appears to provoke a muted neuroinflammatory response, which enhances ongoing neurodegeneration in some models. Anesthetics have both anti-inflammatory and proinflammatory effects depending on the drug and concentration, but in general, appear to play a small role in neuroinflammation. Human studies at the intersection of chronic neurodegeneration, neuroinflammation, and surgery/anesthesia are rare. SUMMARY: The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289136/pdf/nihms348459.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Memory Loss, Alzheimer's Disease and General Anesthesia: A Preoperative Concern.
Thaler A, Siry R, Cai L, García PS, Chen L, Liu R.
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, USA.
J Anesth Clin Res. 2012 Feb 20;3(2). pii: 1000192.
Abstract
BACKGROUND:The long-term cognitive effects of general anesthesia are under intense scrutiny. Here we present 5 cases from 2 academic institutions to analyze some common features where the patient's or the patient family member has made a request to address their concern on memory loss, Alzheimer's disease and general anesthesia before surgery. METHODS:Records of anesthesia consultation separate from standard preoperative evaluation were retrieved to identify consultations related to memory loss and Alzheimer's disease from the patient and/or patient family members. The identified cases were extensively reviewed for features in common. We used Google® (http://www. google.com/) to identify available online information using "anesthesia memory loss" as a search phrase. RESULTS: Five cases were collected as a specific preoperative consultation related to memory loss, Alzheimer's disease and general anesthesiafrom two institutions. All of the individuals either had perceived memory impairment after a prior surgical procedure with general anesthesia or had a family member with Alzheimer's disease. They all accessed public media sources to find articles related to anesthesia and memory loss. On May 2nd, 2011, searching "anesthesia memory loss" in Google yielded 764,000 hits. Only 3 of the 50 Google top hits were from peer-reviewed journals. Some of the lay media postings made a causal association between general anesthesia and memory loss and/or Alzheimer's disease without conclusive scientific literature support. CONCLUSION: The potential link between memory loss and Alzheimer's disease with general anesthesia is an important preoperative concern from patients and their family members. This concern arises from individuals who have had history of cognitive impairment or have had a family member with Alzheimer disease and have tried to obtain information from public media. Proper preoperative consultation with the awareness of the lay literature can be useful in reducing patient and patient family member's preoperative anxiety related to this concern.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708317/pdf/nihms-387114.pdf
Exposición a la anestesia general y riesgo de enfermedad de Alzheimer. Revisión sistemática y meta-análisis
Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis.
Seitz DP, Shah PS, Herrmann N, Beyene J, Siddiqui N.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. seitzd@providencecare.ca
BMC Geriatr. 2011 Dec 14;11:83. doi: 10.1186/1471-2318-11-83.
Abstract
BACKGROUND:Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. METHODS: We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. RESULTS: A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. CONCLUSIONS: A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258207/pdf/1471-2318-11-83.pdf
Modulación anestésica de la neuroinflamación en la enfermedad de Alzheimer
Anesthetic modulation of neuroinflammation in Alzheimer's disease.
Tang JX, Eckenhoff MF, Eckenhoff RG.
Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Anaesthesiol. 2011 Aug;24(4):389-94. doi: 10.1097/ACO.0b013e32834871c5.
Abstract
PURPOSE OF REVIEW: To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. RECENT FINDINGS: A large and growing body of evidence shows that neuroinflammation participates in the development of neurodegeneration associated with Alzheimer's disease. Modulation may be possible early in the pathogenesis, and less so when cognitive symptoms appear. A dysfunctional hypoinflammatory response may permit accelerated damage due to other mechanisms in late disease. The peripheral inflammatory response elicited by surgery itself appears to provoke a muted neuroinflammatory response, which enhances ongoing neurodegeneration in some models. Anesthetics have both anti-inflammatory and proinflammatory effects depending on the drug and concentration, but in general, appear to play a small role in neuroinflammation. Human studies at the intersection of chronic neurodegeneration, neuroinflammation, and surgery/anesthesia are rare. SUMMARY: The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289136/pdf/nihms348459.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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