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F3‐01‐03: Emergence delirium: Manifestation of a vulnerable brain stuck between states?
Author(s) -
Kelz Max B.
Publication year - 2015
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2015.07.224
Subject(s) - wakefulness , consciousness , altered state , neuroscience , arousal , anesthetic , delirium , metastability , psychology , anesthesia , medicine , electroencephalography , physics , intensive care medicine , quantum mechanics
related process and its endogenous regulation are discussed in the context of acute cognitive deficits. Methods: Male C57BL/6 and Ccr2 Cx3cr1mice are studied using a clinically relevant model of orthopedic surgery (commonly associated with delirium especially in the elderly) with an intramedullary fixation of the tibia performed under general anesthesia and postoperative analgesia. Separate cohorts of animals are assessed for neuronal and synaptic plasticity, neuroinflammation, trafficking of immune cells in the hippocampus, attention and cognitive function at different time points. Results: Surgery elicits a distinct neuroinflammatory response with a short-lived infiltration of CCR2macrophages in the hippocampus and a transient opening of the blood-brain barrier. The ensuing pro-inflammatory milieu was associated with impaired pre-synaptic mechanism and long-term potentiation (LTP) deficit, starting at 24h and peaking 72h postoperatively. Memory and attention impairments were evaluated using different behavioral tests and overall indicated a delirium-like state following surgery. Harnessing novel specialized pro-resolving lipid mediators (or stimulating the cholinergic arc) inhibited oxidative stress and NF-KB activity in macrophages, promoting release of anti-inflammatory cytokines, and ultimately preventing signs of postoperative delirium. Conclusions: Selective modulation of postoperative inflammation may provide safer and more effective options to treat delirium and neurological complications after anesthesia and surgery.