Perioperative Extracellular Brain Free-Water Changes for Older Adults Electing Total Knee Arthroplasty with General versus Spinal Anesthesia: A Pilot Study

Author:

Tanner Jared J.1,Amin Manish2,Dion Catherine3,Parvataneni Hari K.4,Mareci Thomas5,Price Catherine C.16

Affiliation:

1. Department of Clinical and Health Psychology, University of Florida College of Health and Health Professions, Gainesville, FL, USA

2. Department of Physics, University of Florida College of Liberal Arts and Sciences, Gainesville, FL, USA

3. Neuropsychology and Structural Imaging Laboratory, University of Florida College of Health and Health Professions, Gainesville, FL, USA

4. Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA

5. Department of Biochemistry and Molecular Biology, University of Florida College of Medicine, Gainesville, FL, USA

6. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Abstract

Background: Recent research shows that older adults electing to undergo total knee arthroplasty with general anesthesia have a pre- to postoperative acute increase in molecular free-water within their cerebral white matter. It is unknown if this change is similar for individuals who elect spinal anesthesia methods. Objective: To explore white matter microstructural changes in a pilot sample of older adults undergoing total knee arthroplasty and receiving general or spinal anesthesia. Methods: We assessed acute perioperative changes in brain white matter free-water in a limited number of older adults electing total knee arthroplasty under spinal anesthesia (n = 5) and matched groups of older adults who received general anesthesia (n = 5) or had no surgery (n = 5). Patterns of free-water changes were also compared in the larger group of older adults electing total knee arthroplasty under general anesthesia (n = 61) and older adults with chronic knee pain who received no surgical intervention (n = 65). Results: Our pilot results suggest older adults receiving general anesthesia had pre- to post-surgery free-water increases extensively throughout their white matter whereas those receiving spinal anesthesia appeared to have less consistent free-water increases. Conclusions: Our pilot results possibly suggest different patterns of perioperative brain white matter free-water changes based on anesthetic approach. We recommend future, larger studies to further examine the effects of anesthetic approach on perioperative brain free-water. The results of our study have potential implications for acute and chronic cognitive changes, perioperative complications, neurodegenerative processes including Alzheimer’s disease, and understanding neuroinflammation.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

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