Evidence map›Paper›PMID 27577265›Full record

ArticleJournal of neuroinflammation2016

Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery.

Jan Hirsch, Susana Vacas, Niccolo Terrando, Miao Yuan, Laura P Sands, Joel Kramer, Kevin Bozic, Mervyn M Maze, Jacqueline M Leung

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neuroinflammation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03120442 (Postoperative Delirium After Total Knee Arthroplasty Under Regional Anesthesia), which is not on this map. Cited by 115 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
115citing papers in PubMed, 12 pooled it
11.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03120442 naunknown statusnot on this mapstarted 2017, after this paper: background citation

Postoperative Delirium After Total Knee Arthroplasty Under Regional Anesthesia: a Comparison Between Intraoperative Sedation With Fentanyl, Fentanyl-dexmedetomidine and Fentanyl-propofol

TypeinterventionalSponsorMahidol UniversityRan2017 to 2022Enrolled600ConditionsPostoperative DeliriumArmsPropofol, Dexmedetomidine, Fentanyl
3 · Its place in the literature

Who cites it

115 citing papers in PubMed, 12 syntheses or guidelines pooled it, 188 citations in OpenAlex.

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55 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Jan HirschDepartment of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA. jan.hirsch@ucsf.edu.ORCID 0000-0001-8077-9736
Susana VacasDepartment of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA.
Niccolo TerrandoDepartment of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA.
Miao YuanCenter of Gerontology, Virginia Tech University, 230 Grove Lane (0555), Blacksburg, VA, 24061, USA.
Laura P SandsCenter of Gerontology, Virginia Tech University, 230 Grove Lane (0555), Blacksburg, VA, 24061, USA.
Joel KramerDepartment of Neurology, Memory and Aging Center, University of California San Francisco, 1500 Owens St. #320, San Francisco, CA, 94158, USA.
Kevin BozicDepartment of Orthopedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA.
Mervyn M MazeDepartment of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA.
Jacqueline M LeungDepartment of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA.
University of California, San Francisco · USVirginia Tech · USSan Francisco VA Medical Center · US

Funding

Pathophysiology of postoperative delirium in older patientsR01AG031795 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI LEUNG, JACQUELINE M · 2009 to 2013
$2.1M
Inflammation resolving mechanism dysregulation in postoperative cognitive declineR01GM104194 · NIGMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MAZE, MERVYN · 2013 to 2016
$1.2M
NIA NIH HHS R01 AG031795NIGMS NIH HHS R01 GM104194
6 · The paper itself

Abstract

backgroundPostoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery.

methodsAfter Institutional Review Board approval and informed consent, we recruited patients undergoing major knee surgery who received spinal anesthesia and femoral nerve block with intravenous sedation. All patients had an indwelling spinal catheter placed at the time of spinal anesthesia that was left in place for up to 24 h. Plasma and CSF samples were collected preoperatively and at 3, 6, and 18 h postoperatively. Cytokine levels were measured using ELISA and Luminex. Postoperative delirium was determined using the confusion assessment method, and cognitive dysfunction was measured using validated cognitive tests (word list, verbal fluency test, digit symbol test).

resultsTen patients with complete datasets were included. One patient developed postoperative delirium, and six patients developed postoperative cognitive dysfunction. Postoperatively, at different time points, statistically significant changes compared to baseline were present in IL-5, IL-6, I-8, IL-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, IL-6/IL-10, and receptor for advanced glycation end products in plasma and in IFN-γ, IL-6, IL-8, IL-10, MCP-1, MIP-1α, MIP-1β, IL-8/IL-10, and TNF-α in CSF.

conclusionsSubstantial pro- and anti-inflammatory activity in the central neural system after surgery was found. If confirmed by larger studies, persistent changes in cytokine levels may serve as biomarkers for novel clinical trials.

Indexed as

AgedAged, 80 and overArthroplasty, Replacement, KneeBiomarkersDeliriumFemaleHumansInflammation MediatorsMaleMiddle AgedOrthopedic ProceduresPerioperative CarePostoperative ComplicationsBiomarkersInflammation MediatorsBlood-brain barrierDeliriumImmune responseSurgery

Identifiers

PMID27577265
PMCPMC5006595
OpenAlexW2513085197

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.