Perioperative Changes of Cognitive Function According to Jugular Vein Insufficiency in Robot-assisted Prostatectomy
Perioperative Changes of Cognitive Function According to Jugular Vein Insufficiency in Robot-assisted Prostatectomy
Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and it has valve
 system to prevent retrograde blood flow to the brain. Anatomical studies revealed that
 bicuspid or tricuspid valves were located in both jugular veins 2 cm above the
 subclavia-jugulars bifurcation and 7-18% of the valves were incompetent. IJVV incompetence
 (IJVVI) may result in retrograde flow which leads to brain congestion and increase of
 intracranial pressure, which can cause brain dysfunctions in some patients. IJVVI has been
 reported to be associated with transient global amnesia (TGA), cough syncope, exertional
 headache, transient ischemic attack, and air embolism. Demographic data are associated with
 the development of IJVVI. Akkawi et al. demonstrated that old age over 50 years and male
 gender are the risk factors for IJVVI. A few physiologic conditions are related with IJVVI
 including elevated intra-thoracic and intra-abdominal pressure, and pulmonary hypertension.
 Robot assisted laparoscopic prostatectomy (RLP) is one of the most common robotic surgery
 because of its significant benefits such as smaller incision, less severe postoperative pain,
 less intraoperative bleeding, and shorter hospital stay compared to traditional radical
 prostatectomy. The patients undergoing RLP are mostly over 60 years old, have neurologic,
 cardiac and pulmonary comorbidities. For RLP, patients are in Trendelenburg position most of
 the time during surgery, which could cause increases in intra-abdominal and intrathoracic
 pressure.
Inclusion Criteria:

 -  over 50 years old

 -  ASA class I or II

 -  Scheduled for robot assisted laparoscopic prostatectomy

 Exclusion Criteria:

 -  previous neurologic deficit

 -  history of psychiatric disease, alcoholism or other drug dependency

 -  Serious hearing or visual impairment or any other comorbidities which would preclude
 neuropsychological tests