Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance.

Background: Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans.

Methods: This was a nested randomised controlled trial within a prospective cohort study; patients age ≥60 yr undergoing noncardiac/non-neurological surgery were randomised to isoflurane or propofol for anaesthetic maintenance. Cerebrospinal fluid (CSF) was collected via lumbar puncture before, 24 h, and 6 weeks after surgery.

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

Objective: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cerebrospinal (CSF) tau, p-tau-181p, or Aβ levels after non-cardiac, non-neurologic surgery in older adults.

Methods: Participants underwent cognitive testing before and 6 weeks after surgery, and lumbar punctures before, 24 h after, and 6 weeks after surgery.

Implant, performance, and retrieval of an atrial leadless pacemaker in sheep.

Background: Medtronic is developing an atrial Micra Transcatheter Pacing System (Medtronic, Minneapolis, Minnesota) and associated retrieval system.

Objective: The purpose of this study was to evaluate chronic atrial Micra retrieval, reimplantation, and chronic pacing performance.

Methods: Sheep were implanted in 2 groups: group 1 (n = 6) for 6 months, a second device implanted, and first retrieved and studied for an additional 6 months; group 2 (n = 6) for 6 months, devices were retrieved, and a second device implanted and observed acutely.

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Objective: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle.

Methods: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed.

An Undiagnosed Paraganglioma in a 58-Year-Old Female Who Underwent Tumor Resection.

Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal.

Pulmonary dysfunction after lung transplantation: the dilemma of coexisting mitral regurgitation.

A case of MR progression after single-lung transplant as a significant contributor to postoperative respiratory failure is reported. Pre-existing MR may progress due to the decompressive effects of lung transplantation on RV dimension and consequent alteration of MV geometry. This case highlights the importance of intraoperative TEE findings, especially pertaining to valvulopathies in the setting of lung transplantation.