Analysis of the influence of risk factors on the development of early postoperative cognitive dysfunction after otolaryngological operations under general anesthesia with controlled hypotension


  • R.A. Bondar National Pirogov Memorial Medical University, Vinnytsia, Ukraine



postoperative cognitive dysfunction, risk factors, ge­neral anesthesia, controlled hypotension, otolaryngology


Background. 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.


Download data is not yet available.


Berger M., Schenning K.J., Brown C.H. 4th, Deiner S.G., Whittington R.A., Eckenhoff R.G. et al. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth. Analg. 2018 Dec. 127(6). 1406-1413. doi: 10.1213/ANE.0000000000003841.

Evered L., Silbert B., Knopman D.S., Scott D.A., DeKosky S.T., Rasmussen L.S. et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br. J. Anaesth. 2018 Nov. 121(5). 1005-1012. doi: 10.1016/j.bja.2017.11.087.

Glumac S., Kardum G., Karanovic N. Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019. Med. Sci Monit. 2019 May 3. 25. 3262-3270. doi: 10.12659/MSM.914435.

Moller J.T., Cluitmans P., Rasmussen L.S., Houx P., Rasmussen H., Canet J. et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998 Mar 21. 351(9106). 857-61. doi: 10.1016/s0140-6736(97)07382-0.

Rasmussen L.S., Johnson T., Kuipers H.M., Kristensen D., Siersma V.D., Vila P. et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol. Scand. 2003 Mar. 47(3). 260-6. doi: 10.1034/j.1399-6576.2003.00057.x.

Quan C., Chen J., Luo Y., Zhou L., He X., Liao Y. et al. BIS-gui­ded deep anesthesia decreases short-term postoperative cognitive dys-function and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav. 2019 Apr. 9(4). e01238. doi: 10.1002/brb3.1238.

Nowak S., Ołdak A., Kluzik A., Drobnik L. Impact of Controlled Induced Hypotension on Cognitive Functions of Patients Undergoing Functional Endoscopic Sinus Surgery. Med. Sci Monit. 2016 Mar 18. 22. 898-907. doi: 10.12659/msm.895964.

Barak M., Yoav L., Abu el-Naaj I. Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature. ScientificWorld Journal. 2015. 2015. 480728. doi: 10.1155/2015/480728.

Alaa A. Niazi Postoperative cognitive function and controlled hypotensive anesthesia in patients undergoing septoplasty. Egyptian Journal of Anaesthesia. 2016 Jan. 32(1). 61-6. doi: 10.1016/j.egja.2015.10.002.

Celebi N., Artukoglu F., Dal D., Saricaoglu F., Celiker V., Aypar U. Effect of hypotensive anesthesia on cognitive functions; a comparison of esmolol and remifentanil during tympanoplasty. Saudi Med. J. 2007 Sep. 28(9). 1357-61.

An J., Fang Q., Huang C., Qian X., Fan T., Lin Y., Guo Q. Deeper total intravenous anesthesia reduced the incidence of early postopera-tive cognitive dysfunction after microvascular decompression for facial spasm. Journal of Neurosurgical Anesthesiology. 2011 Jan. 23(1). 12-7. doi: 10.1097/ANA.0b013e3181f59db4.

Das A., Chhaule S., Bhattacharya S., Basunia S.R., Mitra T., Halder P.S. et al. Controlled hypotension in day care functional en-dosco­pic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J. ­Anaesth. 2016 Jul-Sep. 10(3). 276-82. doi: 10.4103/1658-354X.174919.

Eckenhoff J.E., Compton J.R., Larson A., Durh M.B., Davies R.M. Assessment of cerebral effects of deliberate hypotension by psychologi-cal measurements. Lancet. 1964 Oct 3. 2(7362). 711-4. doi: 10.1016/s0140-6736(64)92539-5.

Jin F., Chung F. Minimizing perioperative adverse events in the elderly. Br. J. Anaesth. 2001. 87(4). 608-24.

Mazzone А., Gianetti J., Picano E., Bevilacqua S., Zucchel­li G., Biagini A., Glauber M. Correlation between inflammatory response and markers of neuronal damage in coronary revascularization with and without cardiopulmonary bypass. Perfusion. 2003 Mar. 18(1). 3-8. doi: 10.1191/0267659103pf622oa.



How to Cite

Bondar, R. (2021). Analysis of the influence of risk factors on the development of early postoperative cognitive dysfunction after otolaryngological operations under general anesthesia with controlled hypotension. EMERGENCY MEDICINE, 16(6), 103–109.



Original Researches