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Current Anesthesiology Reports
Erschienen in: Current Anesthesiology Reports 4/2017

01.12.2017 | Geriatric Anesthesia (S Akhtar, Section Editor)

Neuronal Connectivity, General Anesthesia, and the Elderly

verfasst von: Ramachandran Ramani

Erschienen in: Current Anesthesiology Reports | Ausgabe 4/2017

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Abstract

Purpose of Review

Due to change in demography, 33% of surgeries carried out are in geriatric patients, of which many develop POD and POCD with its major health care and public health consequences. This review will focus on functional connectivity in the brain, its pathophysiological changes with aging and anesthesia, and the consequent effects on brain function.

Recent Findings

Among the RSNs in the brain, DMN activity is significantly altered in in the aging brain and this correlates with the commonly observed mental function changes. Propofol and sevoflurane also affect DMN activity in young healthy subjects. While aging affects the anterior part of the DMN (frontal lobe regions), anesthesia affects activity in the posterior part (PCC, precuneus and, inferior parietal lobe).

Summary

Understanding the effect of surgery and anesthesia on connectivity in elderly is essential in order to be able to optimize brain function after surgery.
Literatur
1.
•• Raichle ME. The restless brain. Brain connectivity. 2011;1(1):3–12. This is a very good review on connectivity—how it came about, origin of the signal, properties, functional significance, etc by a leading investigator in this field. CrossRefPubMedPubMedCentral
2.
• Van Essen DC, Barch DM. The human connectome in health and psychopathology. World Psychiatry. 2015;14(2):154–7. This is an overview of the human connectome project, what the HCP revealed and the projections for the future. CrossRefPubMedPubMedCentral
3.
4.
• O’Brien H, Mohan H, Hare CO, Reynolds JV, Kenny RA. Mind over matter? The hidden epidemic of cognitive dysfunction in the older surgical patient. Ann Surg. 2017;265(4):677–91. Recent review on POCD with a primary focus on fracture hip patients. CrossRef
5.
Hshieh TT, Saczynski J, Gou RY, Marcantonio E, Jones RN, Schmitt E, et al. Trajectory of functional recovery after postoperative delirium in elective surgery. Ann Surg. 2017;265(4):647–53.CrossRefPubMed
6.
Lee TA, Wolozin B, Weiss KB, Bednar MM. Assessment of the emergence of Alzheimer’s disease following coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty. J Alzheimers Dis. 2005;7(4):319–24.CrossRefPubMed
7.
Bohnen N, Warner MA, Kokmen E, Kurland LT. Early and midlife exposure to anesthesia and age of onset of Alzheimer’s disease. Int J Neurosci. 1994;77(3–4):181–5.CrossRefPubMed
8.
•• Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative Management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930–47. This is the guideline from ACS and AGS (incorporating suggestions from NSQUIP guidelines) for the perioperative management of geriatric patients. It emphasises the need for risk screening of eldelry patients for POD and POCD before surgery. CrossRefPubMed
9.
Boveroux P, Vanhaudenhuyse A, Bruno MA, Noirhomme Q, Lauwick S, Luxen A, et al. Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during propofol-induced loss of consciousness. Anesthesiology. 2010;113(5):1038–53.CrossRefPubMed
10.
Schrouff J, Perlbarg V, Boly M, Marrelec G, Boveroux P, Vanhaudenhuyse A, et al. Brain functional integration decreases during propofol-induced loss of consciousness. NeuroImage. 2011;57(1):198–205.CrossRefPubMed
11.
Boly M, Moran R, Murphy M, Boveroux P, Bruno MA, Noirhomme Q, et al. Connectivity changes underlying spectral EEG changes during propofol-induced loss of consciousness. J Neurosci. 2012;32(20):7082–90.CrossRefPubMedPubMedCentral
12.
Gomez F, Phillips C, Soddu A, Boly M, Boveroux P, Vanhaudenhuyse A, et al. Changes in effective connectivity by propofol sedation. PLoS One. 2013;8(8):e71370.CrossRefPubMedPubMedCentral
13.
Tisserand DJ, Jolles J. On the involvement of prefrontal networks in cognitive ageing. Cortex; a journal devoted to the study of the nervous system and behavior. 2003;39(4–5):1107–28.CrossRefPubMed
14.
Tulving E, Kapur S, Craik FI, Moscovitch M, Houle S. Hemispheric encoding/retrieval asymmetry in episodic memory: positron emission tomography findings. Proc Natl Acad Sci U S A. 1994;91(6):2016–20.CrossRefPubMedPubMedCentral
15.
Raichle ME, Snyder AZ. A default mode of brain function: a brief history of an evolving idea. NeuroImage. 2007;37(4):1083–90. discussion 97-9CrossRefPubMed
16.
Raichle ME, MacLeod AM, Snyder AZ, Powers WJ, Gusnard DA, Shulman GL. A default mode of brain function. Proc Natl Acad Sci U S A. 2001;98(2):676–82.CrossRefPubMedPubMedCentral
17.
Damoiseaux JS, Beckmann CF, Arigita EJ, Barkhof F, Scheltens P, Stam CJ, et al. Reduced resting-state brain activity in the “default network” in normal aging. Cereb Cortex. 2008;18(8):1856–64.CrossRefPubMed
18.
Grady CL, Springer MV, Hongwanishkul D, McIntosh AR, Winocur G. Age-related changes in brain activity across the adult lifespan. J Cogn Neurosci. 2006;18(2):227–41.CrossRefPubMed
19.
Spreng RN, Schacter DL. Default network modulation and large-scale network interactivity in healthy young and old adults. Cereb Cortex. 2012;22(11):2610–21.CrossRefPubMed
20.
Ystad M, Hodneland E, Adolfsdottir S, Haasz J, Lundervold AJ, Eichele T, et al. Cortico-striatal connectivity and cognition in normal aging: a combined DTI and resting state fMRI study. NeuroImage. 2011;55(1):24–31.CrossRefPubMed
21.
Wang L, Su L, Shen H, Hu D. Decoding lifespan changes of the human brain using resting-state functional connectivity MRI. PLoS One. 2012;7(8):e44530.CrossRefPubMedPubMedCentral
22.
Greicius MD, Kiviniemi V, Tervonen O, Vainionpaa V, Alahuhta S, Reiss AL, et al. Persistent default-mode network connectivity during light sedation. Hum Brain Mapp. 2008;29(7):839–47.CrossRefPubMedPubMedCentral
23.
Xie G, Deschamps A, Backman SB, Fiset P, Chartrand D, Dagher A, et al. Critical involvement of the thalamus and precuneus during restoration of consciousness with physostigmine in humans during propofol anaesthesia: a positron emission tomography study. Br J Anaesth. 2011;106(4):548–57.CrossRefPubMed
24.
25.
Liu X, Lauer KK, Ward BD, Rao SM, Li SJ, Hudetz AG. Propofol disrupts functional interactions between sensory and high-order processing of auditory verbal memory. Hum Brain Mapp. 2012;33(10):2487–98.CrossRefPubMed
26.
Adapa RM, Davis MH, Stamatakis EA, Absalom AR, Menon DK. Neural correlates of successful semantic processing during propofol sedation. Hum Brain Mapp. 2014;35(7):2935–49.CrossRefPubMed
27.
Schroter MS, Spoormaker VI, Schorer A, Wohlschlager A, Czisch M, Kochs EF, et al. Spatiotemporal reconfiguration of large-scale brain functional networks during propofol-induced loss of consciousness. J Neurosci. 2012;32(37):12832–40.CrossRefPubMed
28.
Martuzzi R, Ramani R, Qiu M, Rajeevan N, Constable RT. Functional connectivity and alterations in baseline brain state in humans. NeuroImage. 2010;49(1):823–34.CrossRefPubMed
29.
Martuzzi R, Ramani R, Qiu M, Shen X, Papademetris X, Constable RT. A whole-brain voxel based measure of intrinsic connectivity contrast reveals local changes in tissue connectivity with anesthetic without a priori assumptions on thresholds or regions of interest. NeuroImage. 2011;58(4):1044–50.CrossRefPubMedPubMedCentral
30.
Palanca BJ, Mitra A, Larson-Prior L, Snyder AZ, Avidan MS, Raichle ME. Resting-state functional magnetic resonance imaging correlates of sevoflurane-induced unconsciousness. Anesthesiology. 2015;123(2):346–56.CrossRefPubMedPubMedCentral
31.
Ranft A, Golkowski D, Kiel T, Riedl V, Kohl P, Rohrer G, et al. Neural correlates of Sevoflurane-induced unconsciousness identified by simultaneous functional magnetic resonance imaging and electroencephalography. Anesthesiology. 2016;125(5):861–72.CrossRefPubMedPubMedCentral
Metadaten
Titel
Neuronal Connectivity, General Anesthesia, and the Elderly
verfasst von
Ramachandran Ramani
Publikationsdatum
01.12.2017
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 4/2017
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-017-0241-6

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