Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Jun 4, 2018
Open Peer Review Period: Jun 6, 2018 - Aug 3, 2018
Date Accepted: Nov 28, 2018
(closed for review but you can still tweet)
A Healthy Volunteer Study: Does Trendelenburg position lead to cognitive decline?
ABSTRACT
Background:
Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after surgical intervention. Aspects of cognitive function can be assessed using various validated cognitive function tests including: N back; Stroop; and Lexical Decision Making Task (LDT). There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD.
Objective:
To assess the effect of the time spent in Trendelenburg position on cognitive function.
Methods:
Volunteers were placed in Trendelenburg for 3 hours, then supine for 30 minutes. Validated cognitive function tests including: 1,2, 3 back; Stroop; and LDT were performed at baseline and every 30 minutes after Trendelenburg position. Cognitive decline was defined as per the ISPOCD trial [1]: a decrease in accuracy from the volunteers’ baseline or an increase in response time (RT) from the volunteers’ baseline by > 2 control group standard deviations (SD).
Results:
Fifteen healthy volunteers were recruited (8 male, 7 female), average age of 69 years (range:57-81) and average BMI of 27.7 kg/m2 (range:20.9-33). Accuracy remained within 2 SDs at all time-points. An increase in RT did occur with 20% showing cognitive decline after 30 minutes in Trendelenburg position, 26.7% after 1 hour, 33.3% after 90 minutes, 26.7% after 120 and 150 minutes; and 40% after 180 minutes. When moved supine, 33.3% had cognitive decline.
Conclusions:
The results of this study indicate that Trendelenburg positioning appears to lead to cognitive decline. This may have implications for patients undergoing prolonged Trendelenburg positioning in laparoscopic colorectal surgery.
Citation
Per the author's request the PDF is not available.
Copyright
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