Serum-neuroproteins, near-infrared spectroscopy, and cognitive outcome after beach-chair shoulder surgery: observational cohort study analyses

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  • Jens Rolighed Larsen
  • Tina Kobborg
  • Pashtun Shahim, University Gothenburg, Dept Chem, SE-41296 Gothenburg, Sverige
  • Kaj Blennow, Dementia Research Institute at UCL, London, United Kingdom., Sverige
  • Lars S Rasmussen, Rigshospitalet, Danmark
  • Henrik Zetterberg, UCL, University of London, University College London, UK Dementia Res Inst, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, University of Gothenburg, University College London

Background: Cerebral hypoxia may occur during surgery but currently used cerebral oxygenation saturation (rSO2) monitors remain controversial with respect to improving clinical outcome. Novel neuroprotein biomarkers are potentially released into systemic circulation and combined with near-infrared spectroscopy (NIRS) could clarify the presence of per-operative cerebral hypoxia. We investigated changes to serum-neuroprotein concentrations post-surgically, paired with NIRS and cognitive outcome, in patients operated in the beach chair position (BCP). Methods: A prospective cohort in 28 shoulder surgery patients placed in the BCP. Blood samples were collected before induction of anaesthesia, and 2 hours and 3-5 days post-operatively. We analysed blood levels of biomarkers including tau and neurofilament light (NFL). We post hoc assessed the cross-wise relationship between biomarker levels and post-surgical changes in cognitive function and intraoperatively monitored rSO2 from NIRS. Results: Serum-NFL decreased from 24.2 pg/mL to 21.5 (P =.02) 2 hours post-operatively, then increased to 27.7 pg/mL on day 3-5 (P =.03). Conversely, s-tau increased from 0.77 pg/mL to 0.98 (2 h), then decreased to 0.81 on day 3-5 (P =.08). In 14/28 patients, episodic rSO2 below 55% occurred, and the duration < 55% was correlated to change in s-tau (P <.05). The cognitive function z-score at 1 week and 3 mo. correlated to the change in tau (P =.01), but not to NFL. Conclusion: Some biomarkers were significantly changed with surgery in the beach chair position. The change was at some points associated to post-operative cognitive decline, and to intraoperative low rSO2. (237).

TidsskriftActa Anaesthesiologica Scandinavica
Sider (fra-til)26-33
Antal sider8
StatusUdgivet - jan. 2021

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