Citicoline in the prevention of postoperative cognitive dysfunction during total intravenous anesthesia

Abstract

At present there is strong evidence of negative influence of generalanesthesia on the brain, with the development of postoperativecognitive dysfunction (POCD). The lack of generallyaccepted approaches to medicamentous prevention of POCDraises the question of intraoperative cerebral protection. Fortyfemale patients (aged 1769 years) who underwent laparoscopiccholecystectomy under total intravenous anesthesia (TIVA)based on propofol and fentanyl were included in the randomizeddouble-blind placebo-controlled study. Twenty patients were randomly assigned to the main group and were given intraoperativelyciticoline (Ceraxon, 1000 mg i.v.), and 20 patientsreceived placebo. Hemodynamics, Harvard standard of patientssafety, bispectral and perfusion indexes were intraoperativelymonitored. Neuropsychological testing including tables ofSchulte, the 10 words recall test and the Hospital Anxiety andDepression Scale (HADS) were performed preoperatively, aswell as on day 1 and day 3 after surgery. Both groups werematched by demographics, coexisting pathology, preoperativecognitive status and anxiety. Anesthesia was adequate with equivalentdemand of anesthetics in all patients. Post-anesthesia recovery period parameters were significantly better in the treatmentgroup compared to placebo (p0.05). On day 1, POCDwas detected in 20% of patients in the treatment group and in50% in the placebo group (p0.05). On day 3, improvement oflong-term memory (by 56%) and attention (by 14.3%) wasobserved in the Ceraxon group comparing to placebo (p0.05).HADS results on day 1 did not show any significant differencebetween the groups, but a positive trend of the decrease of anxietyin the treatment group was observed. Thus, Ceraxon used intraoperatively does not influence on anesthetic consumption,significantly improves the course of postanesthetic recovery andprevents the development of POCD in the postoperative period

Keywords

• general anesthesia
• total intravenous anesthesia
• postoperative cognitive dysfunction
• intraoperative cerebral protection
• citicoline