11-08-10

Older Surgical Patients at Greater Risk for Developing Cognitive ProblemsBy Duke Medicine News and Communications

DURHAM, NC - Patients over the age of 60 who have elective surgeries such as joint replacements, hysterectomies and other non-emergency, inpatient procedures, are at an increased risk for long-term cognitive problems, according to a new study led by Duke University Medical Center researchers.

The study also found that elderly patients who developed these postoperative cognitive problems were more likely to die in the first year after surgery.

“We have known that patients undergoing heart surgery are at risk for cognitive dysfunction -- problems with memory, concentration, processing of information -- but the effects of non-cardiac surgeries on brain function are not as well-understood,” said Terri Monk, MD, an anesthesiologist at Duke and the Durham Veterans Affairs Medical Center, and lead investigator on the study. “Our study found that increasing age put patients in this population at greater risk for cognitive problems and this is significant because the elderly are the fastest growing segment of the population. We know that half of all people 65 and older will have at least one surgery in their lifetime.”

The researchers published their findings in the January 1, 2008 issue of the journal Anesthesiology and the results were published early online on December 27, 2007 on the journal’s Web site. The article is accompanied by a supportive editorial and a companion article detailing the types of cognitive dysfunction that developed and the effects on patients’ daily lives. The study was funded by the National Institute on Aging, the Anesthesia Patient Safety Foundation and the I. Heerman Foundation.

The researchers measured memory and the ability to process information in more than 1000 adult patients of different ages. Patients were tested preoperatively, at the time of hospital discharge, and three months after surgery. More than 200 control subjects took the same tests at the same frequency, but did not undergo surgery or anesthesia.

The study found that many of the young, middle-aged and elderly patients experienced postoperative cognitive dysfunction (POCD) at the time they left the hospital. But three months later, those aged 60 and older were more than twice as likely to exhibit POCD. Those with POCD at both the time of hospital discharge and three months after surgery also were more likely to die within the first year after surgery, Monk said.

“The large difference in the prevalence of POCD between what we termed the elderly -- those aged 60 and over -- and the younger groups

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NewsMonday, November 8, 2010 • Volume 12, Issue 44

we were studying validates the general perception that the elderly are predisposed to cognitive impairment after major surgery,” Monk said. POCD was more common among those patients with lower educational level and a history of a stroke that had left no noticeable neurologic impairment.

“Education protected against postoperative cognitive problems, likely because education may provide an opportunity to condition the brain, and better equip it to withstand injury, much like physical exercise has a protective effect on the body,” Monk said.

The reasons why cognitive decline is associated with early death are not completely understood, but it’s possible that patients with prolonged cognitive dysfunction might be less able to take medicines correctly or may not recognize the need to seek medical care for symptoms of complications, Monk said.

“Studies on normal aging have shown a link between abrupt cognitive decline and early death, so we speculated that surgery-related cognitive dysfunction might have the same effect,” she said.

Why some patients suffer POCD is not known, but one hypothesis is that surgery and the accompanying anesthesia might cause inflammation in the brain that can affect the patient’s ability to learn, retain or remember information, Monk said.

Now that the implications of long-term POCD are better understood, doctors must devise strategies to prevent or mitigate the detrimental effects of surgery and anesthesia on the aging brain, Monk said. The types of interventions and how to implement them will be the subject of further research, she said.

Other researchers on this study include B. Craig Weldon of Duke; and Cyndi Garvan, Duane Dede, Maria van der Aa, Kenneth Heilman and Joachim Gravenstein of the University of Florida.

http://www.dukehealth.org/health_library/news/10209

Department of Anesthesiology Research ConferenceMonday, November 8, 2010 | 5-6 pm | 5685-HAFS

“Animal Models and Stem Cells for Neural Repair”Wenbin Deng, PhDAssistant ProfessorDepartment of Cell Biology & Human AnatomyInstitute for Pediatric Regenerative MedicineUniversity of California, Davis School of Medicine

Terri Monk, MD

ThIs MoNth IN the DepartMeNt of aNesthesIology

November 2010MoNDay tUesDay WeDNesDay thUrsDay frIDay8 9 10 11 12

7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Conference

2:30-3:30 p.m., VAMCVA EchocardiographyConference

5:30-6:30 p.m., 5680A-HAFSPerioperative Leadership Group Meeting

5-6 p.m., 5685-HAFSDepartmental Research Confer-ence: “Animal Models and Stem Cells for Neural Repair” - Wenbin Deng, PhD

5-6 p.m., 5685-HAFSCT Conference: “Perioperative Management of Internal Defibrilla-tors and Pacemakers” - Dr. Ruth Ann Greenfield

5-6 p.m. 6686-HAFSGVTCCM Conference: “Clinical Applications of Bioreactance-Based Non-Invasive Cardiac Out-put Monitoring” - Daniel Burkhoff, MD, PhD

IRB Deadline: Submit 1 originaland 3 copies to Dr. Gan’s office by 5 p.m.

6:30 a.m., 2001DNResident Conference Lecture: “An-esthesia for the Obese Patient” - David Wright, MD

7:15 a.m., 2001DNGrand Rounds: “Counter-Inflam-mation, Immune Paralysis, & Mitochondrial Damage Resolution in Sepsis” - Claude Piantadosi, MD

7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Journal Club

12:00-12:45 p.m., 2003DNCritical Care Grand Rounds: “Pro/Con Debate: SICU vs. NICU” - Dr. David Joseph & Dr. Jessica Mcfarlin

4-5 p.m., 5680A-HAFSPediatric Conference: “One-Lung Ventilation in Pediatric Patients” - Dr. Weronika Crescini

5-6 p.m., 7683A-HAFSResident Education Sessions: “Journal Club”

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7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Conference

2:30-3:30 p.m., VAMCVA EchocardiographyConference

4-6 p.m., 5685-HAFSExecutive Team Meeting

5-6 p.m., 5685-HAFSCT Conference

5-6 p.m. 6686-HAFSGVTCCM Conference: “TBA” - Brian Ohlendorf, MD

IRB Deadline: Submit 1 originaland 3 copies to Dr. Gan’s office by 5 p.m.

6:30 a.m., 2001DNResident Conference Lecture: “Anesthesia for Liver Transplanta-tion &Patients with Liver Disease” - Kerri Wahl, MD

7:15 a.m., 2001DNGrand Rounds: “CRPS -An Update on Pathophysiology & Treatment Options” - Octav Constantinescu, MD, CA3

7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Journal Club

12:00-12:45 p.m., 2003DNCritical Care Grand Rounds: “Nosocomial Infections in the ICU” - Deverick Anderson, MD

4-5 p.m., 5680A-HAFSPediatric Conference

5-6 p.m., 7683A-HAFSResident Education Sessions: “TeamSTEPPS - CUSsing in the OR?!” - Cathleen Peterson-Layne, MD

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7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Conference

2:30-3:30 p.m., VAMCVA EchocardiographyConference

5-6 p.m., 5685-HAFSCT Conference

5-6 p.m. 6686-HAFSGVTCCM Conference: “TBA” - Jessica Meyers, MD

IRB Deadline: Submit 1 originaland 3 copies to Dr. Gan’s office by 5 p.m.

6:30 a.m., 2001DNResident Conference Lecture: “Anesthesia for GI Surgery” - Tim Miller, MD

7:15 a.m., 2001DNGrand Rounds: “Emerging Neuroprotection Strategies in the Multidisciplinary Neuroprotection Laboratories” - David S. Warner, MD

5 p.m., Chen Conference RoomNeuroradiology Conference

Happy Thanksgiving

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7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Conference

2:30-3:30 p.m., VAMCVA EchocardiographyConference

5-6 p.m., 5685-HAFSCT Conference

5-6 p.m. 6686-HAFSGVTCCM Conference: “TBA” - James Feix, MD

IRB Deadline: Submit 1 originaland 3 copies to Dr. Gan’s office by 5 p.m.

6:30 a.m., 2001DNResident Conference Lecture

7:15 a.m., 2001DNGrand Rounds

7:15-8:00 a.m., RM203-Pain ClinicMRC Pain Journal Club

12:00-12:45 p.m., 2003DNCritical Care Grand Rounds: “Acute Kidney Injury in the ICU” - Andrew Shaw, MD

4-5 p.m., 5680A-HAFSPediatric Conference

Upcoming: Annual Departmental Holiday Party: Saturday, December 11, 2010 | Bay 7, Downtown Durham | 7 p.m. to 11 p.m.Nineteenth annual academic evening: Tuesday, May 17, 2011Resident Graduation & Awards Banquet and Subspecialty Recognition Ceremony: Saturday, June 11, 2011

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the BACK pageUpcoming CMe activities

5th Annual Winter Anesthesia and Critical Care ReviewMarch 6-11, 2011 | The Canyons Resort | Park City, UtahFor more information, email Katherine Siler: [email protected] six-day course will focus on reviewing concepts and new advances in pain management, regional anesthesia, critical care, cardiac anesthesia and pediatric anesthesia.

4th annual emerging technologies in the or& Great Fluid DebateJune 12-17, 2011 | Disney’s Grand Floridian Resort & Spa lake Buena Vista, floridaFor more information, email Katherine Siler: [email protected] course will enable the participant to make evidence-based intravenous fluid management decisions in the clinical environments of the operating room, critical care and the emergency room. In addition, it is designed to focus on awareness among anesthesia providers concerning the function, use and limitations of new technology currently being used in the operating suites.

14th annual Duke Cardiothoracic Update and tee Board reviewJointly presented by Departments of Anesthesiology at Duke University and Beth Israel Deaconess Medical Center, Harvard Medical School June 23-26, 2011 | hilton head Marriott resort & spa | hilton head Island, sCFor more information, email: [email protected] your calendars for another year of cutting-edge research and updated infor-mation designed for medical personnel of all skill levels. NeW for 2011: focused course for the tee Board exam in June 2011.

Ultrasound Guided Regional Anesthesia Preceptorship Course2010 Dates Available | Duke University Medical Center, Durham, NCFor more information, email Katherine Siler: [email protected] in the Duke Preceptorship will spend three days in the regional block area, operating rooms and on the floor with post surgery patients observing ultra-sound guided single shot nerve blocks and catheter techniques in a wide variety of clinical scenarios. They will learn how to set up the block area for maximum efficien-cy in the OR environment, improve their decision making ability and make choices in the performance of regional anesthesia. A one-on-one discussion with the Duke Faculty member reviewing cases, scanning techniques and the image library as well as covering handout materials will augment the preceptorship experience.

Visiting preceptorship in Intraoperative transesophageal echocardiography2010 Dates Available | Duke University Medical Center, Durham, NCFor more information, email Jaime C. Cooke: [email protected] in the Duke Intraoperative TEE Preceptorship spend one three-day session in the cardiac operating suites, observing techniques of intraoperative TEE and interpretation of images. Preceptors will participate in active discussions with cardiothoracic anesthesia faculty and fellows, and learn the basic TEE exam. They will also learn how to troubleshoot difficult cases and enhance their decision-making skills in the operating room. Cases will be reviewed with fellows and faculty and im-ages from pathology libraries will be used to augment the preceptorship experience.

Classifiedsreal estate

Charming and adorable recently re-modeled bungalow in quiet Durham neighborhood. Hardwood floors in all bedrooms and living room. Eat-in kitchen with new appliances. Washer and dryer included. Full bath and a half bath, both with ceramic tile. For sale offered at $149,900 or rent.

Contact Trudy Smith at 919-641-9173. [Julie Rosato]

Merchandise

Couch & chair for sale. Asking $200 OBO. Smoke free home. Buyer must be able to pick up. Cash only please email [email protected]. [Sonia Blalock]

November 8-14 Birthday Wishes

Dr. Solomon Aronson Lisa LipscombDanielle Carr Michele MoodyLeah Fitzgerald Christine NelsonDr. Roy Greengrass Diana Stephenson

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