Background and Objectives: Cardiac surgery is associated with various durations of cerebral autoregulation (CA) impairment and can significantly impact cognitive function. Cognitive functions such as memory, psychomotor speed, and attention are significantly impacted after cardiac surgery, necessitating prioritization of these areas in cognitive function tests. There is a lack of research connecting cerebral autoregulation impairment to specific cognitive function domains after cardiac surgery. This study aimed to determine if impaired cerebral autoregulation is associated with postoperative memory impairment and to test the hypothesis that the duration of this impairment affects the development of postoperative memory issues. Materials and Methods: A prospective study was conducted in 2021–2023. After approval of the Ethics Committee and with patient’s written consent, 83 adult patients undergoing elective on-pump coronary artery bypass graft (CABG) surgery were enrolled. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination (MMSE-2) test as a screening tool and the Hopkins Verbal Learning Test-Revised (HVLT-R) to assess memory specifically. To diagnose possible memory impairment (IM), all patients underwent a repeat assessment of cognitive function on the 7th–10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. Cerebral autoregulation status index (Mx) was recorded using Intensive Care Brain Monitoring System software, 9.1.5.23 (Cambridge, UK). Results: According to our research, the incidence of postoperative memory impairment is 30.1%. Temporary cerebral autoregulation impairment occurs in all patients undergoing elective in-pump CABG surgery. The duration of the single longest CA impairment event in seconds (LCAI) and the LCAI dose were higher in patients with postoperative memory impairment, p = 0.006 and p < 0.007, respectively. Conclusions: Cerebral autoregulation impairment is important in developing memory loss after cardiac surgery. The duration and dose of the LCAI event are predictive of postoperative memory impairment.

Background: Postoperative cognitive dysfunction (POCD) commonly affects elderly patients, but the impact of BIS-guided sedation during elective orthopedic surgery under spinal anesthesia remains unclear. The aim was to compare BIS-controlled versus standard clinically guided sedation on POCD in elderly patients undergoing elective knee arthroplasty. Methods: This was a prospective, patient- and outcome assessor-blinded, randomized controlled clinical study. Participants were randomized into two groups: BIS-targeted sedation (BIS group > 70) and standard clinical sedation (non-BIS group). All patients received the same anesthetic and analgesic. The primary outcome was the change in cognitive function over time. Cognitive function was assessed four times using the Addenbrooke’s Cognitive Examination–Revised (ACE-R) questionnaire. Higher scores indicate better cognitive performance. The emotional status was evaluated two times using the Hospital Anxiety and Depression Scale (HADS) . Results: Ninety-two patients (46 per group) were included in the final analysis. No statistically significant differences in total ACE-R score were found between the two groups at any time point ( p > 0.05). Within the BIS group, total ACE-R scores were significantly higher on postoperative day (POD) 90 than preoperatively (PO) (87 (65–96) vs. 92 (70–98), p = 0.007). In the non-BIS group, total ACE-R scores increased significantly at several time points: from PO to 30 POD (87 (48–96) vs. 90.5 (40–98), p = 0.007), from PO to 90 POD (87 (48–96) vs. (91 (40–99), p < 0.001), and from 2 to 30 POD (88 (45–98) vs. 90.5 (40–98), p = 0.005). Significant decline in the number of patients experiencing probable anxiety at 30 POD compared with PO in both groups (BIS 28.3% to 2.2%, p = 0.004; non-BIS 32.6% to 8.7%, p = 0.015). Conclusions: This study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed. Trial registration: ClinicalTrials.gov (NCT06241859, January 28, 2024)

Treatment of acute postoperative pain is an essential part of perioperative care and if left untreated could complicate the healing period. Ketamine blocks nociceptive pain and pain arising from inflammation. Therefore, it is potentially beneficial in the postoperative period. After systematic review using “MEDLINE/PubMed (NLM)” database, we analyzed 18 studies published during 2011–2020 and found that 0.5 mg/kg/h ketamine bolus and 0.1–0.25 mg/kg/h ketamine infusion to be the most effective dose to alleviate postoperative acute pain. Ketamine, when compared with a placebo, did not have any impact on patients’ satisfaction with postoperative pain management and overall well-being. Only three studies revealed more frequent adverse reactions to ketamine after surgery suggesting that ketamine did not have any impact on patients’ postoperational rehabilitation. So, it is the option to recommend low-dose ketamine to be part of multimodal analgesia in acute severe postoperative pain treatment. It can be used in both opioid-dependent and opioid-tolerant patients. Ketamine bolus should be ≤0.35 mg/kg and infusion ≤1 mg/kg/h. One should avoid the use of ketamine in pregnant women, people with cardiovascular diseases, acute psychosis, impaired liver function, increased intracranial, and intraocular pressure. Intranasal ketamine may be considered for children during procedures outside of the operation room.

Background and Objectives: Benzodiazepines (BZDs) are among the most widely prescribed psychotropic drugs globally, and Lithuania is no exception. People with osteoarthritis (OA) often experience chronic pain before arthroplasty, which can cause insomnia, anxiety, and mood disturbances, sometimes leading to BZDs or Z drug prescriptions. The use of these medications, particularly over the long term, may adversely affect cognitive function and increase the risk of falls. Cognitive and psychomotor impairments may hinder rehabilitation, delay mobilization, and reduce quality of life after elective arthroplasty. The aim of this study was to evaluate the prevalence of psychotropic drugs among Lithuanian elderly patients undergoing elective arthroplasty. Materials and Methods: The study, approved by the Regional Bioethics Committee (No. BE-2-53), was conducted at the Department of Anesthesiology, Hospital of the Lithuanian University of Health Sciences Kaunas Clinics. Data on psychotropic medication use, underlying conditions, and treatment duration were obtained from the Hospital’s Information System. Participants were adults aged ≥65 years scheduled for elective arthroplasty with ASA physical status I–III. Data were presented as frequencies (n) and percentages (%). Results: A total of 362 participants were enrolled, of whom 223 (61.6%) used psychotropic medications. Most (63.2%) took BZDs, mainly bromazepam (29.1%) and alprazolam (27.4%). The leading indication was sleep disorders (38.1%), most often treated with alprazolam (34%), followed by anxiety disorders (20.2%), typically managed with bromazepam (24.8%). 99% of participants had been receiving BZDs for more than four weeks. Conclusions: Over half of Lithuanian OA patients undergoing elective arthroplasty used BZDs, underscoring the need for cautious, evidence-based prescribing – particularly in older adults. Regular medication reviews, adherence to national and EU guidelines, and greater use of non-pharmacological therapies are advised. Future research should examine drivers of chronic BZDs use and evaluate deprescribing and alternative treatments for safer, more sustainable care.