Postoperative cognitive dysfunction incidence for regional and general anesthesia in a level four institution in Bucaramanga (Santander, Colombia) during 2017
Abstract
Introduction. Within the aging process, most organic systems maintain their basal functions. However, there is a reduction in functional reserve and the capacity to compensate physiological stress, which makes older patients more prone to postoperative complications. A study was performed in institutions in Bucaramanga to determine the incidence of postoperative cognitive dysfunction and the associated risk factors. Methodology. This was a analytical observational prospective cohort study performed in healthcare institutions in Bucaramanga in 2017 with patients older than 55 years of age under regional, balanced general or total intravenous anesthesia. Results. One hundred and seventy-three operated patients were studied, among which 112 (64.74%) were women and 61 (35.26%) were men. The most commonly used anesthetic techniques were: regional (46.24%) and balanced general (44.51%). Short-term Postoperative Cognitive Dysfunction incidence was 6.36% in previously healthy patients, with an adjusted significant P value (0.001). Cognitive deterioration was detected in 51.41% of patients, with alterations in their mastery of language, attention and memory. This increased for the long-term evaluation. During long-term patient follow-up, it resulted in 11.55%, determining the incidence of delayed Postoperative Cognitive Dysfunction at 17.91%. The anesthetic technique with the highest proportion of long- term dysfunction was mixed anesthesia, compared to regional anesthesia. Discussion. There is currently no standardized definition for Postoperative Cognitive Dysfunction. It has been observed more frequently and for longer extensions in older patients. The study demonstrated a significantly lower early incidence when compared to international articles, but a greater incidence of delayed postoperative dysfunction as a result of more intraoperative complications compared to other studies. Conclusions. Postoperative Cognitive Dysfunction involves multiple risk factors. The study observed a greater association with age, level of education, hypotension and general anesthesia. There was no association between comorbidities and Postoperative Cognitive Dysfunction. The presence of hypotension was determined for developing this dysfunction.
References
Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiology Clinics. 2011;29(1):83-97. Doi: https://doi.org/10.1016/j.anclin.2010.11.011
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911-22. Doi: https://doi.org/10.1016/S0140-6736(13)60688-1
Agnoletti V, Ansaloni L, Catena F, Chattat R, De Cataldis A, Di Nino G, et al. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A studyprotocol. BMC Surgery. 2005;5:12-18. Doi: https://doi.org/10.1186/1471-2482-5-12
Johnson T, Monk T, Rasmussen LS, Abildstrom H, Houx P, Korttila K, et al. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology. 2002; 96:1351-7. Doi:
https://doi.org/10.1097/00000542-200206000-00014
Newman MF, Grocott HP, Mathew JP, White WD, Landolfo K, Reves JG, et al. Neurologic Outcome Research Group and the Cardiothoracic Anesthesia Research Endeavors (CARE) Investigators of the Duke Heart Center: Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke. 2001; 32:2874-81. Doi: https://doi.org/10.1161/hs1201.099803
Phillips-Bute B, Mathew JP, Blumenthal JA, Grocott HP, Laskowitz DT, Jones RH, et al. Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery. Psychosom Med. 2006;68:369-75. Doi: https://doi.org/10.1097/01.psy.0000221272.77984.e2
Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008; 108:18-30. Doi: https://doi.org/10.1097/01.anes.0000296071.19434.1e
Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110(3):548-55. Doi: 10.1097/ALN.0b013e318195b569
Guzmán V. Disfunción cognitiva postoperatoria en pacientes mayores de 50 años bajo anestesia general y regional. Estudio cohorte prospectivo. Biblioteca Virtual UIS.
Folstein MF, Folstein SE, McHugh PR. ‘MiniMental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189-198. Doi: https://doi.org/10.1016/0022-3956(75)90026-6
HortonAM,SloneDG,ShapiroS.Neuropsychometric correlates of the Mini-Mental State Examination: preliminary data. Percept Mot Skills. 1987; 65:64-66. Doi: https://doi.org/10.2466/pms.1987.65.1.64
Anthony JC, LeResche L, Niaz U, Von Korff MR, Folstein MF. Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982;12:397-408. Doi: https://doi.org/10.1017/S0033291700046730
Evered L, Silbert B, Knopman DS, Scott DA, DeKosky T, Rasmussen LS, et al. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-2018. Anesthesiology. 2018;129(5):872-879. Doi: https://doi.org/10.1097/ALN.0000000000002334
Trzepacz PT, Van der Mast RC, Lindesay J, Rockwood K, MacDonald A. Pathophysiology of delirium. Delirium in old age [Internet]. Oxford University Press. 2002 [citado 19 de octubre de 2020];51-90. Recuperado a partir de:
https://global.oup.com/academic/product/delirium-in-old-age9780192632753?cc=co&lang=en&
Tsai T, Sands LP, Leung JM. An Update on Postoperative Cognitive Dysfunction. Advances in Anesthesia. 2010;28(1):269-284. Doi: https://doi.org/10.1016/j.aan.2010.09.003
Tsuang DW, Bird TD. Genetics of dementia. Medical Clinics of North American. 2002; 86:591-614. Doi: https://doi.org/10.1016/S0025-7125(02)00003-2
Hole A, Terjesen T, Brevik H. Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiologica Scandinavica. 1980; 24:279- 287. Doi: https://doi.org/10.1111/j.1399-6576.1980.tb01549.x
Berggren D, Gustafson Y, Eriksson B, Bucht G, Hansson LI, Reiz S, et al. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesthesia&Analgesia Journal. 1987;66:497-504. Doi: https://doi.org/10.1213/00000539-198706000-00003
Williams-Russo P, Sharrock N, Mattis S, Szatrowski T, Charlson M. Cognitive effects after epidural vs general anesthesia in older adults. JAMA. 1995;274:44-50. Doi:
https://doi.org/10.1001/jama.1995.03530010058035
RasmussenLS,LarsenK,HouxP,SkovgaardLT,Hanning CD, Möller JT. ISPOCD group. The International Study of Postoperative Cognitive Dysfunction. The assessment of postoperative cognitive function. Acta Anaesthesiologica Scandinavica. 2001;45:275-89. Doi:
https://doi.org/10.1034/j.1399-6576.2001.045003275.x
Taylor D, Lewis S. Delirium. Journal of Neurology, Neurosurgery & Psychiatry. 1993;56:742-751. Doi: https://doi.org/10.1136/jnnp.56.7.742
Carrillo-Esper R, Peña-Pérez CA, Gómez-Hernández K, Carrillo-Córdova LD, Villena-López EL. Disfunción cognitiva postoperatoria. RevInvestMed Sur (Mex) [Internet]. 2012 [citado 19 de octubre de 2016];19(3):163-169. Recuperado a partir de:
https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=41961
Yoon-Sik O. Incidence and risk factors of acute postoperative delirium in geriatric neurosurgical patients. Journal of KoreanNeurosurgical Society. 2008;43:143-148. Doi: https://doi.org/10.3340/jkns.2008.43.3.143
Folstein MF, Folstein SE, McHugh PR. ‘MiniMental State a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198. Doi: https://doi.org/10.1016/0022-3956(75)90026-6
Horton AM, Slone DG, Shapiro S. Neuropsychometric correlates of the MiniMental State Examination: preliminary data. Percept Mot Skills. 1987;65:64-66. Doi: https://doi.org/10.2466/pms.1987.65.1.64
Gauthier S, Bouchard R, Lamontagne A, Bailey P, Bergman H, Ratner J, et al. Tetrahydroaminoacridine- lecithin combination treatment in patients with intermediate-stage Alzheimer’s disease: results of a Canadian doubleblind, crossover, multicenter study. N Engl J Med. 1990;322:1272-1276. Doi: https://doi.org/10.1056/NEJM199005033221804
Rosselli D, Ardila A, Pradilla G, Morillo L, et al. The mini-mental state examination as a diagnostic selection test for dementia: a colombian population study. Rev Neurol 2000; 30 (5): 428-432. https://doi.org/10.33588/rn.3005.99125
Dokkedal U, Hansen TG, Rasmussen LS, Mengel- From J, Christensen K. Cognitive functioning after surgery in middle-aged and elderly Danish twins. Anesthesiology. 2016;124:312-21. Doi: https://doi.org/10.1097/ALN.0000000000000957
Lobo F. Anestesia, demencias y enfermedad de Alzheimer: ¿coincidencia o certeza? Rev Argent Anestesiol [Internet] . 2012 [Citado 19 de octubre de 2020];70:91-6. Recuperado a partir de: https://www.anestesia.org.ar/search/articulos_completos/1/1/1442/c.pdf
Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. British Journal of Anaesthesia. 2009;103(Suppl.1):i41-i46. Doi: https://doi.org/10.1093/bja/aep291
Avidan MS, Evers AS. Review of clinical evidence for persistent cognitive decline or incident dementia attributable to surgery or general anesthesia. Journal of Alzheimer’s Disease. 2011;24(2):201-16. Doi: https://doi.org/10.3233/JAD-2011-101680
Rundshagen I. Postoperative cognitive dysfunction. Deutsches Arzteblatt international. 2014;111(8):119- 125. Doi: https://doi.org/10.3238/arztebl.2014.0119
Culley DJ, Baxter MG, Crosby CA, Yukhananov R, Crosby G. Impaired acquisition of spatial memory 2 weeks after isoflurane and isoflurane- nitrous oxide anesthesia in aged rats. Anesthesia&Analgesia Journal. 2004;99:1393-1397. Doi:
https://doi.org/10.1213/01.ANE.0000135408.14319.CC
Shors TJ, Miesegaes G, Beylin A, Zhao M, Rydel T, Gould E. Neurogenesis in the adult is involved in the formation of trace memories. Nature. 2001;410:372- 376. Doi: https://doi.org/10.1038/35066584
Lira D, Mar-Meza M, Montesinos R, Herrera-Pérez E, Cuenca J, Castro-Suárez S, et al. Una complicación quirúrgica escasamente sospechada: la disfunción cognitiva postoperatoria. Rev Neuropsiquiatria. 2018;81(2):113. Doi: https://doi.org/10.20453/rnp.v81i2.3339
AnJ,FangQ,HuangC,QianX,FanT,LinY,et al. Deeper Total Intravenous Anesthesia Reduced the Incidence of Early Postoperative Cognitive Dysfunction After Microvascular Decompression for Facial Spasm. Journal of Neurosurgical Anesthesiology. 2011;23(1):12-7. Doi:
https://doi.org/10.1097/ANA.0b013e3181f59db4
Chan M, Cheng P, Lee T, Gin T. BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline. Journal of Neurosurgical Anesthesiology. 2013;25(1):33-42. Doi: https://doi.org/10.1097/ANA.0b013e3182712fba
Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, et al. Cognitive dysfunction after minor surgery in the elderly. Acta anaestheesiol Scand 2003;47:1204-1210. Doi: https://doi.org/10.1046/j.1399-6576.2003.00238.x
Downloads
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
