Correlation of S100B level and postoperative cognitive dysfunction (POCD) events among patients with ear, nose and throat (ENT) surgeries with controlled hypotension

Boby Abdul  Rahman; Prananda Surya Airlangga; Andy Nauman  Saputra; Prihatma  Kriswidyatomo; Agustina  Salinding; Hamzah; Maulidya; Muhtarum  Yusuf

doi:10.15562/bmj.v11i3.3847

Correlation of S100B level and postoperative cognitive dysfunction (POCD) events among patients with ear, nose and throat (ENT) surgeries with controlled hypotension

Boby Abdul Rahman ,

Prananda Surya Airlangga ,

Andy Nauman Saputra ,

Prihatma Kriswidyatomo ,

Agustina Salinding ,

Hamzah ,

Maulidya ,

Muhtarum Yusuf ,

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DOI: https://doi.org/10.15562/bmj.v11i3.3847 |
Published: 2022-12-01

Abstract

Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension.

Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery.

Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not.

Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.

References

Gibson APA, Medina MM. The use of the controlled hypotension in otorhinolaryngology surgeries. Acta Médica Grupo Angeles. 2010;8(3):148-54.
Degoute CS. Controlled Hypotension. Drugs [Internet]. 2007;67(7):1053–76. Available from: http://dx.doi.org/10.2165/00003495-200767070-00007
LINDOP MJ. COMPLICATIONS AND MORBIDITY OF CONTROLLED HYPOTENSION. Br J Anaesth [Internet]. 1975;47(7):799–803. Available from: http://dx.doi.org/10.1093/bja/47.7.799
Ayse Altun G, Fatih Dogu G, Yucel Y, Ibrahim G, Banu C, Kemal Tolga S. Comparison of the Effects of Target-Controlled Propofol Infusion and General Anesthesia with Desflurane on Postoperative Cognitive Functions in Controlled Hypotensive Anesthesia. Int J Anesth Anesthesiol [Internet]. 2021;8(2). Available from: http://dx.doi.org/10.23937/2377-4630/1410123
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's clinical anesthesiology: McGraw-Hill New York; 2013.
Wang F. Postoperative Cognitive Dysfunction: Current Developments in Mechanism and Prevention. Med Sci Monit [Internet]. 2014;20:1908–12. Available from: http://dx.doi.org/10.12659/msm.892485
Niazi AA. Postoperative cognitive function and controlled hypotensive anesthesia in patients undergoing septoplasty. Egypt J Anaesth [Internet]. 2016;32(1):61–6. Available from: http://dx.doi.org/10.1016/j.egja.2015.10.002
Rundshagen I. Postoperative Cognitive Dysfunction. Dtsch Arztebl Int [Internet]. 2014; Available from: http://dx.doi.org/10.3238/arztebl.2014.0119
KRENK L, RASMUSSEN LS, KEHLET H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand [Internet]. 2010;54(8):951–6. Available from: http://dx.doi.org/10.1111/j.1399-6576.2010.02268.x
Michetti F, D’Ambrosi N, Toesca A, Puglisi MA, Serrano A, Marchese E, et al. The S100B story: from biomarker to active factor in neural injury. J Neurochem [Internet]. 2018;148(2):168–87. Available from: http://dx.doi.org/10.1111/jnc.14574
Tomaszewski D. Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update. Biomed Res Int [Internet]. 2015;2015:1–16. Available from: http://dx.doi.org/10.1155/2015/402959
Cata JP, Abdelmalak B, Farag E. Neurological biomarkers in the perioperative period. Br J Anaesth [Internet]. 2011;107(6):844–58. Available from: http://dx.doi.org/10.1093/bja/aer338
Sarengat R, Islam MS, Ardhi MS. Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19. Narra J [Internet]. 2021;1(3). Available from: http://dx.doi.org/10.52225/narra.v1i3.50
Mahmud AA, Anu UH, Foysal KA, Hasan M, Sazib SM, Ragib AA, et al. Elevated serum malondialdehyde (MDA), insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH), and reduced antioxidant vitamins in polycystic ovarian syndrome patients. Narra J [Internet]. 2022;2(1). Available from: http://dx.doi.org/10.52225/narra.v2i1.56
Zahra Z, Ramadhani CT, Mamfaluti T, Pamungkas SR, Firdausa S. Association between depression and HbA1c levels in the elderly population with type 2 diabetes mellitus during COVID-19 pandemic. Narra J [Internet]. 2022;2(1). Available from: http://dx.doi.org/10.52225/narra.v2i1.51
Lorena C, Hamzah H, Maulydia M. Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula. Indones J Anesthesiol Reanim [Internet]. 2021;3(2):54. Available from: http://dx.doi.org/10.20473/ijar.v3i22021.54-61
Mudatsir M, Fajar JK, Wulandari L, Soegiarto G, Ilmawan M, Purnamasari Y, et al. Predictors of COVID-19 severity: a systematic review and meta-analysis. F1000Research [Internet]. 2020 Sep 9;9:1107. Available from: https://pubmed.ncbi.nlm.nih.gov/33163160
Harapan H, Fajar JK, Supriono S, Soegiarto G, Wulandari L, Seratin F, et al. The prevalence, predictors and outcomes of acute liver injury among patients with COVID‐19: A systematic review and meta‐analysis. Rev Med Virol [Internet]. 2021;32(3). Available from: http://dx.doi.org/10.1002/rmv.2304
Thelin EP, Nelson DW, Bellander BM. A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury. Acta Neurochir (Wien) [Internet]. 2016;159(2):209–25. Available from: http://dx.doi.org/10.1007/s00701-016-3046-3
Budianto F, Setiawan P, Hamzah H, Yulianti E. Comparing Alteration of MMSE (Mini-Mental State Examination) Scores as Cognitive Function Test in Geriatrics After General and Regional Anesthesia. Indones J Anesthesiol Reanim [Internet]. 2020;2(2):47. Available from: http://dx.doi.org/10.20473/ijar.v2i22020.47-52
Kwon Y, Jang JS, Hwang SM, Lee JJ, Lee JH, Joo S, et al. Range of S-100β levels during functional endoscopic sinus surgery with moderately controlled hypotension. Eur Arch Oto-Rhino-Laryngology [Internet]. 2017;274(9):3527–32. Available from: http://dx.doi.org/10.1007/s00405-017-4592-x
Senoner T, Velik-Salchner C, Luckner G, Tauber H. Anesthesia-Induced Oxidative Stress: Are There Differences between Intravenous and Inhaled Anesthetics? Oxid Med Cell Longev [Internet]. 2021;2021:1–11. Available from: http://dx.doi.org/10.1155/2021/8782387
Linstedt U, Meyer O, Kropp P, Berkau A, Tapp E, Zenz M. Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgery. Acta Anaesthesiol Scand [Internet]. 2002;46(4):384–9. Available from: http://dx.doi.org/10.1034/j.1399-6576.2002.460409.x
Silva FP, Schmidt AP, Valentin LS, Pinto KO, Zeferino SP, Oses JP, et al. S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery. Eur J Anaesthesiol [Internet]. 2016;33(9):681–9. Available from: http://dx.doi.org/10.1097/eja.0000000000000450