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Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy

Authors
 Go Un Roh  ;  Won Oak Kim  ;  Koon Ho Rha  ;  Byung Ho Lee  ;  Hae Won Jeong  ;  Sungwon Na 
Citation
 ARCHIVES OF GERONTOLOGY AND GERIATRICS, Vol.64 : 167-171, 2016 
Journal Title
 ARCHIVES OF GERONTOLOGY AND GERIATRICS 
ISSN
 0167-4943 
Issue Date
2016
MeSH
Aged ; Brain/blood supply ; Cerebrovascular Circulation ; Cognition/physiology* ; Female ; Head-Down Tilt/physiology* ; Hemodynamics/physiology ; Humans ; Jugular Veins/anatomy & histology* ; Jugular Veins/physiopathology* ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; Postoperative Complications/epidemiology* ; Postoperative Period ; Prevalence ; Prostatectomy/methods* ; Republic of Korea/epidemiology ; Robotic Surgical Procedures/methods* ; Venous Insufficiency/complications* ; Venous Insufficiency/diagnosis ; Venous Insufficiency/epidemiology*
Keywords
Elderly ; Internal jugular vein valve incompetence ; Robotic surgery ; postoperative cognitive dysfunction
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0167494316300139
DOI
10.1016/j.archger.2016.01.013
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Oak(김원옥)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146452
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