Perioperative changes in cerebral ischemic markers in the cerebrospinal fluid after preoperative XXXX treatment.

@entity1 @entity3625 @entity3624 @entity908 @entity3931 @entity51 @entity520 @entity880 @entity460
BACKGROUND: Elderly @entity1 with previous organ damage are at risk for minor @entity51 after major surgery. Spinal catheter analgesia is used whenever possible in this group and enables regular cerebrospinal fluid (CSF) sampling. @entity3931 , a @entity460 blocker, may have neuroprotective effects. We examined whether preoperative treatment with @entity3931 affects ischemic markers in the CSF during extracranial surgery. METHODS: We performed a prospective, randomized, placebo-controlled, double-blind study in @entity1 (ASA III or IV, 65-85 years) that underwent elective implantation surgery of the hip joint with intrathecal catheter anesthesia. Starting 15 h before surgery, @entity1 received either 30 microg x kg(-1) h(-1) of @entity3931 (n = 20) or 0.9% saline solution (placebo, n = 23) as a central venous infusion. The concentrations of neuron-specific enolase, @entity3625 , @entity908 -kinase, @entity880 and pH in the CSF were determined before and immediately after surgery as well as 6 and 24 h after surgery. RESULTS: Before surgery, the baseline CSF pH was normal in all @entity1 . Immediately after surgery it fell significantly to 7.08 +/- 0.29 in the placebo group and non-significantly to 7.27 +/- 0.38 in the treatment group; all values were normalized at 6 and 24 h after surgery in both groups. In the placebo group, @entity880 levels rose significantly from 1.48 +/- 0.28 mmol l(-1) before surgery to 1.77 +/- 0.27 mmol l(-1) immediately after surgery, and to 2.03 +/- 0.32 mmol l(-1) 24 h after surgery. In the treatment group, @entity880 concentrations remained stable up to 6 h after surgery (1.55-1.62 mmol l-1), while an increase to 2.10 +/- 0.48 mmol l(-1) was observed 24 h after the operation. Neuron-specific enolase, hypo- @entity3624 and @entity908 -kinase showed no change in either group. CONCLUSION: In conclusion, preoperative @entity3931 treatment reduced intraoperative CSF @entity520 and delayed surgery-related increases in @entity880 concentration in the CSF by several hours in elderly, comorbid @entity1 at risk for @entity51 .
