RESUMO
Postoperative delirium (POD) after cancer surgeries can be a result of chemo brain, anesthesia, surgery duration, and preoperative cognitive impairment. Although older age and preoperative cognitive dysfunction were reported to increase the risk of POD in noncardiac surgery, the role of preoperative cognitive function and age in the development of POD after all types of cancer surgeries is not clear. This study aimed to determine the relationship between preoperative cognitive function and likelihood of POD after cancer surgeries. This study used three main online databases and followed PRISMA guidelines. English language original articles that examined preoperative cognitive function before solid tumor cancer surgery and assessed patients for postoperative delirium were included. We employed the random effect meta-analysis method. The overall incidence of POD ranged from 8.7% to 50.9%. The confusion assessment method was the most common tool used to assess delirium. Mini-mental state evaluation (MMSE), Mini-cog, and Montreal cognitive assessment were the most common tools to assess cognitive function. The pooled (total observation = 4676) random effects SMD was estimated at -0.84 (95% confidence interval [CI]: -1.30 to -0.31), indicating that lower MMSE scores before surgery are associated with a higher risk of POD. The pooled (total observation = 2668) random effects OR was estimated at 5.17 (95% CI: 2.51 to -10.63), indicating preoperative cognitive dysfunction can significantly predict the occurrence of POD after cancer surgeries. In conclusion, preoperative cognitive function is an independent and significant predictor of POD after solid tumor cancer surgeries.
RESUMO
OBJECTIVE: Major surgeries and the accompanied acute stress response are associated with poor immune system function and extensive immunologic changes. This study was conducted to compare postsurgery stress responses after transversus abdominis plane (TAP) blocks and epidural anesthesia in patients undergoing laparoscopic cholecystectomy under general anesthesia. MATERIALS AND METHODS: Sixty patients who were candidates for laparoscopic cholecystectomy were enrolled in this randomized controlled trial. After randomly assigning patients into 2 groups (30 patients in epidural anesthesia and 30 patients in the TAP block group), the degree of pain and stress responses (serum level of blood glucose, C-reactive protein [CRP], interleukin-1, tumor necrosis factor-alpha, cortisol) of patients were measured preoperatively and at 6 and 24 hours after surgery. RESULTS: Mean blood glucose, serum cortisol, CRP, and white blood cell decreased significantly 6 and 24 hours after the intervention in both groups and differed significantly between the 2 groups ( P -value <0.05). The proportion of patients with a pain score greater than 3 at 6 and 12 hours after surgery was significantly higher in the Epidural group compared with the TAP block group, although this figure was significantly higher in the TAP block group 24 hours after surgery. DISCUSSION: A significant decrease in the mean blood sugar, serum cortisol, CRP, and white blood cell in both groups at 6 and 24 hours after the surgery was noted. The pain score decreased 24 hours after surgery in the epidural anesthesia group and increased in the TAP block group.