Analysis of the influence of risk factors on the development of early postoperative cognitive dysfunction after otolaryngological operations under general anesthesia with controlled hypotension
Keywords:postoperative cognitive dysfunction, risk factors, general anesthesia, controlled hypotension, otolaryngology
AbstractBackground. Postoperative cognitive dysfunction (POCD) is an impairment of higher mental functions that may occur postoperatively and are related to the surgery and anesthesia. Medical and social impact of POCD is undoubted due to its high incidence (up to 30 % after non-cardiac surgery), high expenses related to the restoration of cognitive functions, as well as the need in social adaptation of the patients. Therefore, the question of the pathogenetically based method of choice for correction of cognitive dysfunction in the perioperative period remains a controversial issue. Purpose of the study is to identify and analyze risk factors for the development of POCD after otolaryngological surgeries under general anesthesia with controlled hypotension. Materials and methods. A prospective study was conducted in 127 otolaryngological patients (77 men and 50 women) undergoing surgical intervention under general anesthesia with controlled hypotension. Age of the patients was 40.17 ± 14.96 years. In addition to general clinical and laboratory data, pre- and postoperative testing of neurocognitive functions was performed, perioperative indicators of antioxidant systems and the activity of free radical oxidation of lipids and proteins were investigated, as well as indicators of neuron-specific and inflammatory markers in the blood. Statistical processing of the obtained data was performed in the statistical package SPSS 20 (SPSS Inc.). Results. Early POCD developed in 31 (24.4 %) patients. Differences between individuals with POCD and without POCD were found (p < 0.05) among the following indicators: age, level of education, reoperation, duration of surgery and anesthesia, intraoperative controlled hypotension, depth of intraoperative sedation, results of assessment of cognitive status after surgery, levels of products of protein and lipid peroxidation, neuron-specific enolase, interleukin-18 in the blood, the presence of postoperative infection. No differences were found (p > 0.05) among the following indicators: sex, body mass index, smoking, the presence of comorbid pathology, assessment of surgical and anesthestic risk in accordance with the American Society of Anesthesiologists, the level of intraoperative controlled hypotension, perioperative levels of glucose, lactate, neuron-specific enolase in the blood, perioperative assessment of anxiety and depression, preoperative levels of antioxidant system indicators and the activity of free radical oxidation of lipids and proteins in the blood. Conclusions. Patients with early POCD are characterized by significant changes in oxidative stress, both in the dynamics compared to baseline and in comparison with individuals without POCD. Early POCD is also characterized by worse results of neuropsychological testing in the postoperative period than in patients without POCD. Increased levels of interleukin-18 and a marker of neuronal damage — neuron-specific enolase versus baseline values is a typical perioperative dynamics. It was found that independent risk factors for early POCD after otolaryngological surgery and general anesthesia with controlled hypotension in the regression analysis are: old age, low level of education, reoperation, duration of intraoperative controlled hypotension, depth of intraoperative sedation.
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