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

Article type: Research Article

Authors: Tanner, Jared J.^{a; *} | Amin, Manish^b | Dion, Catherine^c | Parvataneni, Hari K.^d | Mareci, Thomas^e | Price, Catherine C.^{a; f}

Affiliations: [a] Department of Clinical and Health Psychology, University of Florida College of Health and Health Professions, Gainesville, FL, USA | [b] Department of Physics, University of Florida College of Liberal Arts and Sciences, Gainesville, FL, USA | [c] Neuropsychology and Structural Imaging Laboratory, University of Florida College of Health and Health Professions, Gainesville, FL, USA | [d] Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA | [e] Department of Biochemistry and Molecular Biology, University of Florida College of Medicine, Gainesville, FL, USA | [f] Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Correspondence: [*] Correspondence to: Jared J. Tanner, PhD, or Catherine C. Price, PhD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, USA. Tel.: +1 352 273 5272; E-mails: [email protected] or [email protected].

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.

Keywords: Alzheimer’s disease, anesthesia, brain, cognition, diffusion magnetic resonance imaging, neuroinflammation, total knee arthroplasty

DOI: 10.3233/JAD-221246

Journal: Journal of Alzheimer's Disease, vol. 96, no. 3, pp. 1243-1252, 2023