Postoperative cognitive dysfunctions and operating position

Abstract

Background. Postoperative cognitive dysfunction (POCD) is a common complication after surgery with general anae­sthesia in the elderly. However, roughly 12 % of patients over age 65 had postoperative cognitive dysfunction (POCD) three months after surgery. This is an important issue in perioperative care as extensive surgery on older patients becomes more common. POCD is usually transient. Its pathogenesis is multifactorial, with the immune response to surgery probably acting as a trigger. Factors that elevate the risk of POCD include old age, pre-existing cerebral, cardiac, and vascular disease, low educational level, and intra- and postoperative complications. The findings of multiple randomi­zed controlled trials indicate that the method of anesthesia does not play a causal role for prolonged cognitive impairment. POCD is associated with poorer recovery and increased utilization of social financial assistance. POCD is associated with a decrease in quali­ty of life, loss of function, and increased mortality. Materials and methods. When examining cognitive functions according to Schulte tables, no significant changes were found in patients operated on in pron-position. Results. In patients operated on in the BCP, a signi­ficant difference was found — by 3 days of the postoperative period, the mean binding time of numbers in the elderly was significantly longer than in young and middle-aged patients. Similar changes were observed when testing for phonetic speech activity. On the 3rd day after the operation, elderly patients could be called fewer words per minute than younger patients in the BCP group. Conclusions. When two intraoperative positions was compared the development of the POCD was observed in a group of elderly patients operated by the BCP. Patients of all ages who undergoing surgery in the BCP had a significantly longer time before extubation than patients who undergoing surgery in a pron-position.