Variants of Correction for Intraoperative Hemodynamic Responses and Their Impact on the Development of Postoperative Cognitive Dysfunction in Elderly Patients with Concomitant Hypertension

O.A. Loskutov, O.M. Druzhyna, V.H. Kolesnikov

Abstract


This work deals with the studying the impact of different regimens of intraoperative blood pressure correction on the incidence of postoperative cognitive dysfunction in elderly patients undergoing coronary artery bypass grafting. Material and methods. The study included 43 patients with coronary heart disease, who underwent coronary artery bypass grafting at the State institution «Institute of the Heart» of the Ministry of Healthcare of Ukraine. The average age of patients was 67.5 ± 2.3 years, the average weight — 87.4 ± 5.2 kg. Males — 35 people (81.4 %), females — 8 people (18.6 %). All patients were divided into two groups by the way of correction for intraoperative blood pressure increase (more than 30 % of the «working» one). The first group (n = 23) consisted of patients whose correction was performed by deeper anesthesia. In the second group (n = 20), blood pressure was corrected by urapidil (Ebrantil) infusion. Results and discussion. Results of short-term auditory-verbal memory test showed that on the 7th day after the surgery, patients of the I group had an average of 13.60 ± 1.07 % — in comparison with those in patients from the II group. Test results on the fine motor skills of hands also showed that group II patients had 4.75 ± 0.12 % which was higher on average 33.9 ± 2.5 % relative to similar values in group I patients. Thus, intraoperative high blood pressure increase often has a multifactorial causes, and before the introduction of additional doses of hypnotics, it is necessary to assess the depth of anesthesia. And for the correction of high blood pressure during general anesthesia, drugs with a controlled and predictable antihypertensive effect should be used.


Keywords


coronary artery bypass grafting; anesthesia; advanced age; hypertension; cognitive dysfunction

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DOI: https://doi.org/10.22141/2224-0586.3.74.2016.77520

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