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GENERAL ARTICLES

Perioperative Plasma Concentrations of Stable Nitric Oxide Products Are Predictive of Cognitive Dysfunction After Laparoscopic Cholecystectomy

G. Iohom, FCARCSI^*, S. Szarvas, MD DEEA^*, V. Larney, FCARCSI^*, J. O’Brien, FCARCSI^*, E. Buckley, FCARCSI^*, M. Butler, MSc, and G. Shorten, PhD^*

Departments of *Anaesthesia and Intensive Care Medicine and Clinical Biochemistry, Cork University Hospital, Cork, Ireland

Address correspondence and reprint requests to Professor G. Shorten, Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland. Address e-mail to shorteng{at}shb.ie

In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100ß protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I–II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100ß protein and plasma concentrations of stable NO products (nitrate/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100ß protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100ß) are associated with early POCD. The former represents a potential biochemical predictor of POCD.

IMPLICATIONS: The results of this prospective observational study suggest that preoperative (and postoperative) plasma concentrations of stable nitric oxide products (but not S-100ß) are associated with early postoperative cognitive dysfunction. The former represents a potential biochemical predictor of postoperative cognitive dysfunction.

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