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Anesth Analg 2007;104:1298
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260372.38206.b3

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Correlation of the Depth of Anesthesia with POCD (Postoperative Cognitive Dysfunction)

Vijay Gaba, MD

Clinical Assistant Professor, University of North Dakota, Staff Anesthesiologist, MeritCare Medical Center, Fargo, ND, vijay.gaba{at}meritcare.com

To the Editor:

Farag et al. (1) reported better cognitive function at 4–6 wk postoperatively, with respect to the ability to process information. No difference was observed in the working memory index and verbal memory index.

I would like to point out, however, that the authors did not include a control group in their study and have also failed to mention if theirs was a blinded study.

One very interesting finding in the current study was that deeper levels of anesthesia were associated with better cognitive function. This conclusion is different from those observed in other similar studies performed by Wong et al. (2) and Gaba et al. (3) that found no correlation between cognitive function and depth of anesthesia postoperatively. The authors of the current study do give a nice explanation for their results and that is protection against POCD could potentially be a result of the neuroprotective effect of isoflurane (4).

Finally, I would like to point out that the authors’ claim that theirs was the first study to correlate intraoperative anesthetic level to remote POCD is not true. The above-mentioned two studies (2,3), also attempted to correlate depth of anesthesia with POCD.

REFERENCES

  1. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia, as assessed by the bispectral index, related to postoperative cognitive dysfunction and recovery? Anesth Analg 2006;103:633–40.[Abstract/Free Full Text]
  2. Wong J, Song D, Blanshard H, et al. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth 2002;49:13–18.[Abstract/Free Full Text]
  3. Gaba VK, Mathews DM, Zhaku B, Neuman GG. Correlation of the intraoperative bispectral index score (BIS) with incidence of postoperative cognitive disorders (POCD) in the geriatric population. Anesth Analg 2004;98:S-71.
  4. Warner DS. Isoflurane neuroprotection: a passing fancy, again? Anesthesiology 2000;92:1226–8.[ISI][Medline]



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A. Schubert, E. Farag, and E. J. Mascha
Correlation of the Depth of Anesthesia with POCD (Postoperative Cognitive Dysfunction)
Anesth. Analg., May 1, 2007; 104(5): 1298 - 1299.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press