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Non-neurological surgery and cerebrospinal fluid biomarkers for neuronal and astroglial integrity.

Journal article
Authors Rolf Anckarsäter
Henrik Anckarsäter
Sara Bromander
Kaj Blennow
Caroline Wass
Henrik Zetterberg
Published in Journal of neural transmission (Vienna, Austria : 1996)
Volume 121
Issue 6
Pages 649-653
ISSN 1435-1463
Publication year 2014
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Centre for Ethics, Law, and Mental Health
Pages 649-653
Language en
Keywords Spinal anesthesia; Orthopedic surgery; Tau protein; Stress; Bupivacaine
Subject categories Neurochemistry


Non-neurological surgery has both acute and long-term effects on the brain. Markers for Alzheimer pathology may be used to study surgically induced neurological changes relevant for postoperative confusion, asthenia or cognitive decline. Inflammatory biomarkers, total tau (T-tau) and phosphorylated tau (P-tau) were recently shown to increase progressively in the cerebrospinal fluid (CSF) during surgery for nasal CSF leak, suggesting a neuroinflammatory response with signs of neuronal damage. We used a study group of 35 patients, undergoing knee arthroplasty with a spinal blockade and propofol sedation, to replicate this finding. Five CSF biomarkers were analyzed before, 3 h after and on the morning after the interventions: T-tau and P-tau for cortical axonal integrity and tangle pathology, respectively, the 42 amino acids form of amyloid β (Aβ42) for plaque formation, neurofilament light (NFL) for the integrity of large-caliber myelinated axons and glial fibrillary acidic protein (GFAp) for astroglial cell integrity. CSF T-tau concentrations increased significantly during and after surgery (p = 0.028) and were significantly correlated with the administered doses of bupivacaine. P-tau, Aβ42 and NFL remained unchanged, while the mean GFAp concentration increased with a large standard deviation. CSF T-tau and P-tau correlated significantly with the CSF/serum albumin ratios as an indicator of blood-brain barrier permeability. Findings from earlier studies showing a significant increase in biomarkers for Alzheimer's pathology during surgery were partly replicated, as neurochemical signs of impaired cortical axonal integrity during non-neurological surgery were detected. Bupivacaine may be involved in these reactions.

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