Effect of Low Dose Ketamine on Postoperative Cognitive Dysfunction in Geriatric Patients Undergoing Abdominal Surgery

Öz

Aim: We aimed to investigate the effect of low dose ketamine on cognitive functions in geriatric patients undergoing elective abdominal surgery under general anesthesia. Methods: Forty patients aged 65 and older planned for elective abdominal surgery were randomly divided into two groups. While 5 ml saline was administered to the control group, ketamine group received iv 0,5 mg/kg ketamine 5 minutes before induction. Hemodynamic variables, BIS, etCO2 and ET-Sevo were measured every 15 min until the end of the operation. Furthermore, extubation time, time to spontaneous eye opening and Aldrete Scores were measured. Mini Mental State Examination (MMSE), Trieger Dot Test (TDT) and Clock Drawing Test (CDT) were performed 24 hours prior to the operation and repeated 1 and 6 hours after the operation. Results: There were not statistical differences in terms of demographic characteristics (p>0.05). Total remifentanil consumption in control group was significantly higher than ketamin group (p<0.001).There were no differences between two groups with respect to the extubation time, time to eye opening and Aldrete Scores at 2nd and 5th minutes. (p>0.05). MMSE, TDT, CDT values measured preoperatively didn’t vary statistically between the groups (p>0.05) but results at the postoperative 1st and 6th hours were higher in ketamine group (p<0.01). Results at postoperative 1st hour were lower in the control group, whereas results at the 6th hour increased although they didn’t return to the preoperative values. Results at postoperative 1st hour in ketamine group were significantly different and lower than the preoperative and postoperative values (p<0.001). Conclusion: We concluded that low dose ketamine had positive effects on cognitive functions in geriatric patients undergoing elective abdominal surgery under general anesthesia.

Anahtar Kelimeler

• Ketamine,Geriatric Ptients,Cognitive Dysfunction

Abdominal Cerrahi Uygulanan Geriatrik Hastalarda Düşük Doz Ketamin'in Postoperatif Kognitif Disfonksiyon Üzerine Etkisi

Öz

Amaç: Genel anestezi altında elektif abdominal cerrahi uygulanan geriatrik hastalarda düşük doz ketaminlerin kognitif fonksiyonlar üzerine etkisini araştırmayı amaçladık. Yöntemler: Elektif cerrahi girişim planlanan 65 yaş ve üstü 40 hasta rastgele iki gruba ayrıldı. Kontrol grubuna 5 ml salin uygulanırken, ketamin grubu indüksiyondan 5 dakika önce iv 0,5 mg / kg ketamin aldı. Hemodinamik değişkenler, BIS, etCO2 ve ET-Sevo operasyonun sonuna kadar her 15 dakikada bir ölçüldü. Ayrıca ekstübasyon süresi, spontan göz açma zamanı ve Aldrete skorları ölçüldü. Mini Zihinsel Durum İncelemesi (MMSE), Trieger Dot Testi (TDT) ve Clock Drawing Test (CDT) operasyondan 24 saat önce yapılmış ve operasyondan 1 ve 6 saat sonra tekrarlanmıştır. Bulgular: Demografik özellikler açısından istatistiksel farklılık yoktu (p> 0.05). Kontrol grubundaki toplam remifentanil tüketimi ketamin grubundan anlamlı olarak yüksekti (p <0.001). Ekstübasyon süresi, göz açma süresi ve 2. ve 5. dakikalarda Aldrete skorları açısından iki grup arasında fark yoktu. (P> 0.05). Ameliyat öncesi ölçülen MMSE, TDT, CDT değerleri gruplar arasında istatistiksel olarak değişmedi (p> 0.05), ancak ketamin grubunda postoperatif 1. ve 6. saatlerin sonuçları daha yüksekti (p <0.01). Ameliyat sonrası 1. saatteki sonuçlar kontrol grubunda daha düşük iken, ameliyat öncesi değerlere dönmemelerine rağmen 6. saatteki sonuçlar artmıştır. Ketamin grubunda postoperatif 1. saatteki sonuçlar preoperatif ve postoperatif değerlerden anlamlı derecede farklı ve düşüktü (p <0.001). Sonuç: Genel anestezi altında elektif abdominal cerrahi uygulanan geriatrik hastalarda düşük doz ketaminlerin bilişsel işlevler üzerinde olumlu etkileri olduğu sonucuna vardık.

Anahtar Kelimeler

• Ketamin,Geriatrik Hastalar,Kognitif Disfonksiyon

Kaynakça

1. References 1. Drummond GB. The assesment of postoperative mental function. Br J Anaesth 1975;47:130-42. 2. Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME. Post-operative delirium: Predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992; 759-67 3. Breslin DS, Reid JE, Mirakhur RK, Hayes AH, McBrien ME: Sevoflurane-nitrous oxide anaesthesiasupplemented with remifentanil:effect on recovery and cognitive function. Anaesthesia 2001;56:114-19. 4. Moller JT, Rasmussen LS: Cerebral complications following anaesthesia. Refresher Course Lectures. 7th ESA Annual Meetings, 1999; p.1-3. 5. Solano AM, Pypendop BH, Boscan PL, Ilkiw JE. Effect of intravenous administration of ketamine on the minimum alveolar concentration of isoflurane in anesthetized dogs. Am J Vet Res. 2006;67(1):21-5. 6. Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Hudetz AG, et al. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand. 2009 Aug;53(7):864-72. 7. Tsai SK, Lee C, Kwan WF, Chen BJ. Recovery of cognitive functions after anesthesia with desflurane or isoflurane and nitrous oxide. Br J Anaesth. 1992 Sep;69(3):255-8. 8. Tzabar Y, Asbury AJ, Millar K: Cognitive failures after general anaesthesia for day-case surgery. Br J Anaesth 1996;76(2):194-197. 9. Zuurmond WW, Balk VA, Van Dis H, Leeuwen L, Paul EA: Multidimensionality of psychological recovery from anaesthesia. Analysing six recovery tests. Anaesthesia 1989; 44: 889-892. 10. Ulusoy B, Kayaaltı B, Yegül İ, Akarsu D: Propofolün üst kortikal beyin fonksiyonları üzerindeki etkileri. Türk Anest Rean Cem Mecmuası 1992; 20: 259-260. 11. Akman H, Evlice YE, Aslan S, Akyön G, Eriş O: Genel anesteziden sonra motor ve mental işlevlerin geriye dönüşü. Çukurova Üniversitesi Tıp Fakültesi Dergisi 1990;3:295-302. 12. Mac Intyre P. General Surgery. Alman KG, Wilson HI. (Eds)Oxford. Handbook of anaesthesia. New York: Oxford University Pres; 2002.p.277-98. 13. Billard V, Servin F, Guignard B, Junke E, Bouverne MN, Hedouin M et al. Desflurane-remifentanil-nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features. Acta Anaesthesiol Scand 2004;48(3):355-64. 14. Gesztesi Z, Mootz BL, White PF. The use of a remifentanil infusion for hemodynamic control during intracranial surgery. Anesth Analg 1999;89(5):1282-7. 15. Chen X, Zhao M, White PF, Li S, Tang J, Wender RH, et al. The recovery of cognitive function after general anesthesia in elderly patients. A comparison of desflurane and sevoflurane. Anesth Analg 2001;93:1489-94. 16. Aydın ON, Uğur B, Erpek G, Özgün S. İndüksyonda subanestezik dozda uygulanan ketaminin anesteziden uyanma üzerine etkisi. ADÜ Tıp Fakültesi Dergisi. 2002;3:19-24. 17. Solano AM, Pypendop BH, Boscan PL, Ilkiw JE. Effect of intravenous administration of ketamine on the minimum alveolar concentration of isoflurane in anesthetized dogs. Am J Vet Res. 2006;67(1):21-5. 18. Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth 1998; 81:449-62. 19. Kalman SH, Jensen AG, Ekberg K. Early and late recovery after major abdominal surgery. Comparison between propofol anesthesia with and without nitrous oxide and isoflurane anesthesia. Acta Anaesthesiol Scan. 1993;37:730-6. 20. Çobanoğlu H, Tavlan A, Topal A, Kılıçaslan A, Erol A, Otelcioğlu Ş. The effect of sevoflurane and desflurane on the early postoperative cognitive functions in geriatric patients. Eur J Gen Med 2013;10(1):32-37. 21. Savageau JA, Stanton B, Jenkins CD, Frater RWM: Neuropsychological dysfunction following elective cardiac operations. J Thorac Cardiovasc Surg 1982; 84:595-600. 22. An H, Liu Q, Chen Y, Lin W. Evaluation of MR-derived cerebral oxygen metabolic index in experimental hyperoxic hypercapnia, hypoxia, and ischemia.40(6):2165-72-2009. 23. Maule S, Caserta M, Bertello C, Verhovez A, Naso D, . Bisbocci D, et al. Cognitive decline and low blood pressure: The other side of the coin. Clin Exp Hypertens. 2008 Nov;30(8):711-9.