Effects of Fentanyl with Levobupivacaine on Cognitive Functions and Cerebral Oxygenation

Abstract

Preoperative risk assessment may fail in most patients who may be exposed to postoperative neurological sequelae. The aim of this study was to assess the effects of Fentanyl added to epidural levobupivacaine on cerebral oxygenation and cognitive functions. There was a negative correlation between age and MMT, and a positive correlation between SpO2 and MMT. MMT scores of Group 2 at postoperative first hour and fifth hours were lower than those of Group 1. It was concluded that while fentanyl added to epidural local anesthetic had no effect on hemodynamic parameters, SpO2, and right-left cerebral oxygen saturation, and although it may have caused a decrease in MMT scores in the early postoperative period, it did not cause impairment in cognitive functions.

Keywords

• Epidural anesthesia, fentanyl, levobupivacaine, cognitive function, cerebral oxygenation

Effects of Fentanyl with Levobupivacaine on Cognitive Functions and Cerebral Oxygenation

Öz

Postoperatif nörolojik sekele maruz kalabilen çoğu hastada preoperatif risk değerlendirmesi yetersiz kalabilir. Bu çalışmanın amacı epidural levobupivakaine fentanilin eklenmesinin serebral oksijen ve kognitif fonksiyonlara etkisini araştırmaktır. Yaş ile MMT arasında negatif, SPO2 ile MMT arasında pozitif korelasyon vardı. Postoperatif 1 ve 5. saatte Grup 2 MMT skorları Grup birinkinden düşüktü. Epidural lokal anesteziye fentanilin eklenmesi hemodinamik parametreleri, oksijenasyonu ve sağ-sol serebral oksijenasyonu etkilemediği, erken postoperatif peryodda MMT skorlarında azalma neden olmasına rağmen kognitif fonksiyonlarda bir bozukluk meydana getirmedi

Anahtar Kelimeler

• Epidural anestezi, fentanil, levobupivakaine, kognitif fonksiyon, serebral oksijenasyon

References

1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of pa- tients for the clinician. J Psychiatr Res 1975;12:189–98
2. Kramer M, German PS, Antony JC. Patterns of Mental Disorders among the elderly Residents of Easttern Baltimore, J Am Geriatric Soc 1985; 33:236-45
3. Wilson E, David A, Mackenzie N, Grant IS. Sedation During Spinal Anesthesia: Comparison of Propofol and Midazolam. BrJ Anaesth 1990;64:48-52
4. Molloy DW, Standish TI. A guide to the standardize mini mental state examination, Int Psychogeriatr 1997;9:87-94
5. Gerson LW, Rousseau EW, Bernstein E. Multicenter study of case finding in elderly emergency department patients. Acad Emergency Medicine 1995;2:729-34
6. Schwarz G, Litscher G, Delgado PA, Klein GE. An NIRS matrix for detecting and correcting cerebral oxygen de- saturation events during surgery and neuroendovascular procedures. Neurol Res 2005;27:423–8
7. Jalowiecki P, Ploro A, Dzlurdzik P, Krawczyk L, Karpel E, Dyaczynska-Herman A. Regional cerebral oxygenation monitoring in children undergoing elective scoliosis sur- gery with controlled urapidil induced hypotension. Med Sci Monit 1998;4:987–92
8. Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone–alphadolone. Br Med J 1974;2:656–9

9. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen de- saturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg 2009;87:36–45
10. Atkinson RS, Rushman GB, Davies NJH, Lee JA. Lee's Synopsis of Anaesthesia. 11th ed. Saint Louis: Butterworth-Heinemann; 1993;691–719
11. Kleinman W. Spinal, Epidural and Caudal Blocks, In: Morgan GE, Mikhail MS, Murray MJ (eds). Clinical Anesthesia. 3rd edition. North America: McGraw-Hill Companies; 2002;253–82
12. Rasmussen L, Stygall J, Newman SP. Cognitive Dysfunction and Other Long-Term Complications of Surgery and Anesthesia, In: Miller RD (ed). Miller’s Anesthesia. 7th edition. Churchill Livingstone Elsevier, Philadelphia. 2009;2805–19
13. Kramer M, German PS, Antony JC. Patterns of mental dis- orders among the elderly residents of eastern Baltimore. J Am Geriatric Soc 1985;33:236–45
14. Briedler A, Juckenhofel S, Larsen R. Postoperative cog- nition disorders in elderly patients. The results of the "International Study of Postoperative Cognitive Dysfunction" (ISPOCD 1). Anaesthesist 1999;48:884–95
15. Rasmussen LS, Johnson T, Kuipers HM, et al. Does an- aesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaes- thesia in 438 elderly patients. Acta Anaesthesiol Scand 2003;47:260–6
16. Chaney MA. Side effects of intrathecal and epidural opi- oids. Can J Anaesth 1995;42:891–903
17. An H, Liu Q, Chen Y, Lin W. Evaluation of MR-derived ce- rebral oxygen metabolic index in experimental hyperoxic hypercapnia, hypoxia, and ischemia. Stroke 2009;40:2165
18. Edmonds HL Jr, Ganzel BL, Austin EH 3rd. Cerebral oxim- etry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004;8:147–66
19. Maule S, Caserta M, Bertello C, et al. Cognitive decline and low blood pressure: the other side of the coin. Clin Exp Hypertens 2008;30:711–9
20. Higami T, Kozawa S, Asada T, et al. Retrograde cerebral perfusion versus selective cerebral perfusion as evalu- ated by cerebral oxygen saturation during aortic arch re- construction. Ann Thor Surg 1999;67:1091–6
21. Hoppenstein D, Zohar E, Ramaty E, Shabat S, Fredman B. The effects of general versus spinal anesthesia on frontal cerebral oxygen saturation (RSO2) in geriatric patients undergoing emergency surgical fixation of the neck of fe- mur. J Bone Joint Surg 2005;87:393
22. Shin HK, Nishimura M, Jones PB, et al. Mild induced hy- pertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia. Stroke 2008;39:1548–55