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Br J Anaesth. 2019 Dec;123(6):808-817. doi: 10.1016/j.bja.2019.08.024. Epub 2019 Oct 3.

Exposure to surgery under general anaesthesia and brain magnetic resonance imaging changes in older adults.

Author information

1
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: sprung.juraj@mayo.edu.
2
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
3
Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
4
Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
5
Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
6
Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Abstract

BACKGROUND:

Preclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions.

METHODS:

This is a cross-sectional analysis of 70-91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment.

RESULTS:

Of 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference -0.023 mm, [95% confidence interval (CI) -0.041 to -0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have 'abnormal thickness' compared with those without surgery (odds ratio=1.45, [95% CI 1.10-1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts.

CONCLUSIONS:

This study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.

KEYWORDS:

MRI; aging; cerebral infarct; cortical thinning; general anaesthesia; neurodegeneration; surgery

PMID:
31587833
PMCID:
PMC6883493
[Available on 2020-12-01]
DOI:
10.1016/j.bja.2019.08.024
[Indexed for MEDLINE]

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