A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery

Purpose: Ulinastatin, a urinary trypsin inhibitor, is widely used to treat acute systemic inflammatory disorders. However, its effects on early postoperative cognitive function have not been fully elucidated. The objective of this study was to investigate the effect of ulinastatin on serum IL-6, TNF-alpha, CRP and S100 beta protein concentration and early postoperative cognitive function in patients after abdominal surgery. Methods: Eighty ASAI-II patients older than 65 years, scheduled for elective abdominal surgery were randomly divided into 2 groups (n = 40 each): ulinastatin and control. After induction of anesthesia, the ulinastatin group received 10,000 units/kg of ulinastatin intravenously before surgical incision and 5000 units/kg on post-op days 1-3. Cognitive function was assessed preoperatively and on post-op day 7 using a battery of nine neuropsychological tests. Serum IL-6, TNF-alpha, CRP and S100 beta protein levels were determined preoperatively, at the end of surgery and on post-op days 1-3. Results: There were significant decrements in each neuropsychological test, except for the Digit Span Backward Test between groups. Based on neuropsychological testing, the ulinastatin group had a lower incidence of postoperative cognitive dysfunction (POCD) than the control group (2.5% versus 27.5%, p < 0.05). In the control group, serum S100 beta protein and IL-6 concentrations increased at the end of surgery and on post-op days I and 2. The ulinastatin group had lower serum S100 beta protein and IL-6 concentrations than those in the control group (p < 0.05). Conclusion: Ulinastatin may be effective in reducing the incidence of early postoperative cognitive dysfunction. (C) 2013 Elsevier Ireland Ltd. All rights reserved.