Anesthesia can cause cognitive problems in elderly with low vitamin D - many studies

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Preoperative Vitamin D levels and respiratory complications of general anesthesia - Oct 2018

Niger J Clin Pract. 2018 Oct;21(10):1278-1283. doi: 10.4103/njcp.njcp_102_18.
Tas N1, Noyan T2, Yagan O3, Hanci V4, Canakci E1.
1 Dept of Anesthesiology and Reanimation, Faculty of Medicine, Ordu University, Ordu, Turkey.
2 Dept of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey.
3 Dept of Anesthesiology and Reanimation, Faculty of Medicine, Hitit University, Çorum, Turkey.
4 Dept of Anesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

AIMS: This research aims to investigate whether there is a correlation between the respiratory complications occurring in patients under general anesthesia and preoperative Vitamin D levels.

SETTINGS AND DESIGN: The study was a prospective observational study.

MATERIALS AND METHODS:
This study included 95 adult cases. The cases had total 25-hydroxyvitamin D (25OHD) levels identified in blood samples before the operation. Patients given routine general anesthesia and were assessed in terms of respiratory complications during anesthesia induction, extubation, anesthesia recovery, and the first 24-h postoperative.

STATISTICAL ANALYSIS USED: The Shapiro-Wilk test, Student's-t-test, one-way ANOVA test, Pearson correlation coefficient, and Chi-square tests were used.

RESULTS:
The mean 25OHD vitamin level identified in the preoperative period was 13.00 ± 6.57 ng/mL, with 25OHD vitamin levels found to be significantly low in female cases compared to male cases (P < 0.05). There was a statistically significant negative relationship between age and 25OHD vitamin levels identified (P = 0.045). When assessed in terms of surgery types, there was no significant difference found in Vitamin D levels in terms of surgery type. When examined for complications in the induction, extubation period, and postoperative recovery period, there was a significant difference identified between 25OHD vitamin levels and these complications (P < 0.01).

CONCLUSIONS:
This research observed that patients with low preoperative 25OHD vitamin levels encountered respiratory complications related to general anesthesia more often. Especially, in the early postoperative period, there is a very significant difference between complications and low 25OHD vitamin levels.

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Slower recovery from Sevoflurane Anesthesia in elderly mice having low Vitamin D - June 2022

Effect of Different Vitamin D Levels on Cognitive Function in Aged Mice After Sevoflurane Anesthesia
Front. Aging Neurosci., 10 June 2022 | https://doi.org/10.3389/fnagi.2022.940106
Jialei Zhang1,2†, Xiaoling Zhang3, Yongyan Yang1, Jun Zhao3, Wenqing Hu4 and Yonghao Yu1*†
1Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
2Department of Anesthesiology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, China
3Department of Oncology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, China
4Department of Gastrointestinal Surgery, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, China

Although the biological relationship between vitamin D (VD) deficiency and cognitive function has been recognized by many scholars, the theoretical mechanisms involved are still not well-understood. In this study, we demonstrated the role of VD in alleviating the cognitive dysfunction in aged mice caused by sevoflurane anesthesia. Forty female C57BL/6 mice aged 12 months were selected for the experiment. VD (-) and VD (+) mouse models and sevoflurane anesthesia models were established. Mice were randomly divided into normal elderly group (NC group), normal aged mice + sevoflurane anesthesia treatment group (NS group), aged VD (-) mice + sevoflurane anesthesia treatment group [VD (-) group], and aged VD (+) + sevoflurane anesthesia treatment group [VD (+) group]. To compare the emergence time after sevoflurane anesthesia in aged mice with different levels of VD and to test the cognitive function of four groups through the water maze. Inflammatory factor expression and cholinergic activity in hippocampus tissue of all mice were measured at the end of behavioral tests. These data show that, low levels of VD aggravated the delayed emergence and cognitive dysfunction in aged mice caused by sevoflurane anesthesia, while higher levels of VD mitigated this impairment by enhancing cholinergic activity and reducing inflammatory factor expression in the hippocampus.
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Preoperative Hypovitaminosis D Can Predict Development of Postoperative Cognitive Dysfunction - 2019

J Anest & Inten Care Med 8(5): JAICM.MS.ID.555746 (2019) 001
Ahmed M Salem1*, Ahmed E Salem2, Maha M Hagras3, Adel F Al Kholy4
1Department of Anesthesiology & ICU, Benha University, Egypt
2Department of Anesthesiology & ICU, Tanta University, Egypt
3Department of Clinical Pathology, Tanta University, Egypt
4Department of Medical Biochemistry, Benha University, Egypt

Objectives: Preoperative estimation of serum 25OH-vitamin D (25OHD) level in patients undergoing surgical procedures extending for
>60min under sevoflurane anesthesia and correlate these levels with frequency of postoperative (PO) cognitive dysfunction (POCD).
Patients & Methods: 254 patients; 127 Kuwaiti (Group A) and 127 Egyptian patients (Group B ) were evaluated clinically and gave blood
samples for ELISA estimation of serum 25OHD. Vitamin D sufficiency status was defined as sufficient (≥75nmol/L), insufficient (50-75nmol/L)
and deficient (<50nmol/L) level. Cognitive function was assessed preoperatively, 48-hr, 1-wk and 2-wk PO using the Digit span (DS) test.
Anesthetic was induced using propofol, fentanyl and rocuronium, and was maintained with sevoflurane, fentanyl and rocuronium with
continuous non-invasive hemodynamic monitoring. Study outcome included the frequency and severity of hypovitaminosis D (HVD) and POCD
in studied patients.

Results: Only 31 patients (12.2%) had sufficient VD level with significant difference in favor of Group B. All surgeries were conducted
uneventfully within mean operative time of 154.4±37min and mean blood loss of 415±158ml. Median preoperative DS score was 6, at 48-hr, 1-wk and 2-wk PO, 153, 124 and 95 patients, respectively had score of <6.
Preoperative serum 25OHD level showed negative significant correlation with age and BMI, and positive significant correlation with male gender and duration of education. Median PO score on DS testing showed positive significant correlation with serum 25OHD, especially in Kuwaiti patients. Statistical analyses defined preoperative low serum 25OHD as significant specific predictor for POCD.

Conclusion: POCD is a common incident event among patients underwent major surgeries consuming long operative time under sevoflurane
anesthesia. Old age, high BMI, duration and severity of surgery are co-factors for POCD. Preoperative HVD has a pronounced effect and correlated with these precipitating factors and could be used as independent significant predictor for POCD.
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Cognitive problems after surgery with low vitamin D might be related to anesthesia

• Postoperative cognitive dysfunction 8 X more likely if low vitamin D – March 2018
• Delirium 2.7 X more likely after hip fracture and low vitamin D – May 2015

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