Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy |
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| Affiliation: | 1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea;2. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea;3. Department of Urology, Urological Science Institute and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea;1. Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan;2. Department of Neurosurgery, Aichi Medical University, Aichi, Japan;1. Department of Pediatric Neurosurgery, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel;2. Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York, USA;3. Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children''s Hospital, St. Louis, Missouri, USA;4. Pediatric Neurosurgery, Charité Universitaetsmedizin, Berlin, Germany;5. Division of Pediatric Neurosurgery, Santobono-Pausilipon Children''s Hospital, Naples, Italy;6. Department of Woman, Child, General and Specialistic Surgery - “Luigi Vanvitelli“ Campania University, Naples, Italy;1. Helios Klinik Kipfenberg, Kipfenberg, Germany;2. Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany;1. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan;2. Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan;1. Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid /IECSCYL, 47003 Valladolid, Spain;2. Pulmonology Service, University and Polytechnic Hospital La Fe, Ciber de Enfermedades Respiratorias (Ciberes), València, Spain;3. Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona-SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain |
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| Abstract: | Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p < 0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further. |
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| Keywords: | Internal jugular vein valve incompetence Elderly postoperative cognitive dysfunction Robotic surgery |
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