Sixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C).
Sample Count
64
Age
≥65
Control
Sham
control group(n=32)
Experiment
TEAS group(n=32)
Indicator
TNF-αIL-6MMP-9S100-βDeliriumComaAssessment Method for the intensive care unitRichmond Agitation-Sedation Scale
Auxiliary Medication
The patients were induced using 0.1–2 mg/kg sufentanil, 0.05–0.2 mg/kg midazolam, 0.3 mg/kg etomidate, and 0.2 mg/kg cisatracurium. A reinforced catheter was inserted after 2 minutes of cisatracurium administration. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. Propofol 4–6 mg/kg/h and remifentanil 0.1–0.3 mg/kg/min were intravenously (iv) infused and cisatracurium 0.05 mg/kg was administrated as intermittent iv boluses.
Stimulation Method
TEAS
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
-
-
2/100 Hz
disperse-dense wave
-
starting from 30 minutes before induction of anesthesia until the end of the surgery
This study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were significantly increased at T2–3 in both the groups (P<0.05). Compared with group TEAS, serum levels of TNF-α and IL-6 were higher at T2–3 and serum levels of MMP-9 and S100β were higher at T3 in group C (P<0.05). The intraoperative anesthetic consumptions were less in group TEAS than group C. TEAS can alleviate POD in older patients with silent lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of BBB.
Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction: a preliminary study.
Abstract
PURPOSE: This study aims to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients with silent lacunar infarct and preliminarily to determine the relationship among TEAS, blood-brain barrier (BBB), neuroinflammation, and POD. PATIENTS AND METHODS: Sixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C). Patients in the group TEAS received TEAS (disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of both sides starting from 30 minutes before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. At 0 minute before the treatment of TEAS, 30 minutes after skin incision, and after completion of surgery (T(1-3)), blood samples were extracted to detect the concentration of serum tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), and S100beta. We assessed patients for delirium and coma twice daily in the first 3 postoperative days using the Confusion Assessment Method for the intensive care unit and the Richmond Agitation-Sedation Scale. RESULTS: This study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T(1), the serum concentrations of IL-6, TNF-alpha, MMP-9, and S100beta were significantly increased at T(2-3) in both the groups (P<0.05). Compared with group TEAS, serum levels of TNF-alpha and IL-6 were higher at T(2-3) and serum levels of MMP-9 and S100beta were higher at T(3) in group C (P<0.05). The intraoperative anesthetic consumptions were less in group TEAS than group C. CONCLUSION: TEAS can alleviate POD in older patients with silent lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of BBB."
Souce
Clin Interv Aging. 2018 Oct 24;13:2127-2134. doi: 10.2147/CIA.S183698. eCollection 2018.
