LIVIA STOCCO SANCHES VALENTIN
Projetos de Pesquisa
Unidades Organizacionais
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
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bookPart Delirium e Disfunção Cognitiva Pós-operatória(2017) XAVIER, Marcelo Souza; VALENTIN, Lívia Stocco Sanches; CARMONA, Maria José Carvalho- S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery A prospective observational study(2016) SILVA, Fernando P.; SCHMIDT, Andre P.; VALENTIN, Livia S.; PINTO, Katia O.; ZEFERINO, Suely P.; OSES, Jean P.; WIENER, Carolina D.; OTSUKI, Denise A.; TORT, Adriano B. L.; PORTELA, Luis V.; SOUZA, Diogo O.; AULER JR., Jose O. C.; CARMONA, Maria J. C.BACKGROUND Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). OBJECTIVE The study aims to evaluate the association between POCD and serum levels of S100B and NSE after coronary artery bypass grafting surgery (CABG). DESIGN Prospective observational study. SETTING Single university teaching hospital. PATIENTS We investigated 88 patients undergoing CABG. MAIN OUTCOMES MEASURES Cognitive function was measured preoperatively, and at the 21st and 180th postoperative days (i.e. 6 months after surgery). S100B protein and NSE serum levels were evaluated preoperatively, after induction of anaesthesia, at the end of surgery and at 6 and 24 h after surgery. RESULTS The incidence of POCD was 26.1% at 21 days after surgery and 22.7% at 6 months after surgery. Increased serum levels of S100B protein and NSE were observed postoperatively and may indicate brain damage. CONCLUSION Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG.
- Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction(2015) VALENTIN, Lívia Stocco Sanches; PIETROBON, Ricardo; AGUIAR JUNIOR, Wagner de; RIOS, Ruth Pinto Camarão; STAHLBERG, Mariane Galzerano; MENEZES, Iolanda Valois Galvão de; OSTERNACK-PINTO, Kátia; CARMONA, Maria José CarvalhoObjective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.
conferenceObject Lower educational level is a possible risk factor for postoperative cognitive dysfunction after surgery under general anesthesia(2012) VALENTIN, Livia S. S.; ANDRADE, Jessica F.; SOUZA, Leticia Maria A.; LUZ, Vinicius Fernando Da; OSTERNACK-PINTO, KatiaIntroduction: Elderly patients with postoperative cognitive dysfunction (POCD) have an increased risk of mortality, especially after major surgery1. High educational level is regarded as a protective factor for developing dementia, especially Alzheirmer's disease2, but little is known about educational level in the development of POCD. Objective: This study aims evaluating the influence of the level of education in the incidence of POCD in elderly patients undergoing surgery under general anesthesia. Methods: Seventy one patients older than 60 years old undergoing surgery under general anesthesia were evaluated before surgery and on 7th postoperative (P.O.) day by TICS (Telephone Interview for Cognitive- Standardized, instrument that assesses by telephone the skills of spatial and temporal orientation and memory, requiring only the ability to verbal understanding). Low educational level (LEL) was defined as 4 or less years of formal education and high educational level (HEL) was defined as 8 or more years of formal education. Statistical analysis was performed with SPSS 17.0, using nonparametric analysis of ordinal data with repeated measurements. P values inferior to 0,05 were considered significant. Results: HEL and LEL groups presented different TICS values since preoperative period (P = 0.032). For comparison between pre and postoperative period, the HEL group presented TICS values of 29.8±5.9 before surgery and 29.0±7.3 at 7th P.O. and for LEL group the TICS values were 17.6±3.1 and 16.7±2.6, respectively, without difference between groups (P = 0.07). Conclusions: The differences in the TICS values observed since the preoperative period are normal for the educational levels evaluated3. Although the decreasing of mean TICS value of the LEL group (5.11%) was greater than the HEL group (2.68%), the sample size analyzed wasn't enough the prove that low educational level is a risk factor for POCD.- Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial(2016) VALENTIN, Livia Stocco Sanches; PEREIRA, Valeria Fontenelle Angelim; PIETROBON, Ricardo S.; SCHMIDT, Andre P.; OSES, Jean P.; PORTELA, Luis V.; SOUZA, Diogo O.; VISSOCI, Joao Ricardo Nickenig; LUZ, Vinicius Fernando da; TRINTONI, Leticia Maria de Araujo de Souza; NIELSEN, Karen C.; CARMONA, Maria Jose CarvalhoPostoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100 beta was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100 beta serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100 beta might be related with some degree of neuroprotection.
conferenceObject - The MentalPlus (R) Digital Game Might Be an Accessible Open Source Tool to Evaluate Cognitive Dysfunction in Heart Failure with Preserved Ejection Fraction in Hypertensive Patients: A Pilot Exploratory Study(2018) PEREIRA, Valeria Fontenelle Angelim; VALENTIN, Livia Stocco SanchesIntroduction. Cognitive dysfunction with heart failure with reduced ejection fraction (HFrEF) is well studied. However, there are comparative studies with heart failure and preserved ejection fraction (HFpEF). Cognitive dysfunction diagnosis usually demands a long neuropsychological battery. We developed MentalPlus (R) digital game to overwhelm that issue. Methods. As a pilot study, we evaluated 60 patients with systemic hypertension and HFpEF. They were submitted to TICS (Telephone Interview Cognitive Status) to evaluate the general cognitive function and 25 minutes of MentalPlus (R) digital game evaluation. Results. The results disclosed 60 hypertensive patients. All of them presented with HFpEF. Patients presented a mean age of 56 +/- 10 years; 46% male; LVMi (g/m(2)) mean 110 +/- 20; educational attainment of 9 years or more; mean income of 8 Brazilian minimum wages. The TICS results disclosed 28 +/- 3.7. MentalPlus (R) digital game evaluation disclosed preserved values for the phases I, III, IV, V, VI, and VII. Phase II, short-term memory related, was below the normals values that were assigned. This group of patients presented a normal general cognition by both evaluations, except for specific functions displayed above, disclosed by MentalPlus (R). The MentalPlus (R) was designed to possibly evaluate specific cognitive functions separately, like attention, memory, executive function, and language, because each phase evaluates specific functions shortly. Conclusion. Hypertensive HFpEF patients presented in general a normal cognition, except for some aspects related to short-term memory. The MentalPlus (R) digital game, compared with TICS, presented similar general results. It is an advantage that MentalPlus (R) software could be used to assess cognitive function, in general and individually, and be an open tool shortly.