Katarakt cerrahisi geçiren yetişkinlerde anestezi tipinin bilişsel işlevler üzerindeki rolü

Yıl 2020, , 1112 - 1115, 01.12.2020

Yeliz Kılıç , Mustafa Bilgeç , Burak Sarıoğlan Gülay Erdoğan Kayhan , Mehmet Güleç Ahmet Özer

https://doi.org/10.28982/josam.836439

Öz

Amaç: Postoperatif bilişsel işlev bozukluğu (POCD), anesteziyologlar ve cerrahlar için büyük bir endişe kaynağıdır. Ancak anestezi tipi ile postoperatif bilişsel işlevler arasındaki ilişki net olarak belirlenememiştir. Katarakt cerrahisi geçiren hastalarda POBD gelişimi üzerine üç anestezi yönteminin (lokal, topikal ve genel anestezi) etkisini karşılaştırmak.
Yöntemler: Bu prospektif gözlemsel çalışmaya katarakt ameliyatı geçiren 19 ve 64 yaşlarındaki hastalar alındı. Tüm hastalar üç anestezi grubundan birine atandı; genel (n=27), yerel (n=23) ve topikal (n=27). Bilişsel durum ameliyat öncesi ve sonrası (1. saat, 1. gün, 1. hafta) Blessed Orientation-Memory-Concentration (BOMC) testi kullanılarak değerlendirildi.
Bulgular: Üç anestezi grubu, yaş hariç, temel hasta özellikleri ve hemodinamik veriler açısından benzerdi (P>0,05). Yaş, gruplar arasında anlamlı olarak farklıydı ki bunlar arasında genel anestezi grubundaki hastalar en genç, lokal anestezi grubundakiler ise en yaşlılardı (P<0,001). Lokal ve topikal gruplarda tüm anestezi sonrası BOMC skorları başlangıç değerlerine göre azaldı (P>0,05). Ancak 1. saat BOMC skoru genel anestezi grubunda istatistiksel olarak anlamlı olmayan bir artış gösterdi (P=0,554). Lokal anestezi grubunda bazal ortalama BOMC skoru diğer gruplara göre daha yüksekti (P=0,037), postoperatif BOMC skorları ise üç grup arasında benzerdi (P>0,05).
Sonuç: Katarakt cerrahisi geçiren yetişkin hastalarda lokal, topikal ve genel anestezinin postoperatif bilişsel işlevler üzerinde farklı bir etkisi yoktu. Üç anestezi yöntemi arasında postoperatif BOMC skorlarında da istatistiksel bir fark yoktu.

Anahtar Kelimeler

Anestezi, Katarakt cerrahisi, Postoperatif bilişsel işlev bozukluğu

Role of anesthesia type on cognitive functions in adults undergoing cataract surgery

Öz

Aim: Postoperative cognitive dysfunction (POCD) is a major concern for anesthesiologists and surgeons. However, the relationship between anesthesia type and postoperative cognitive functions has not been clearly identified. The aim of this study is to compare the impact of three anesthetic methods, local, topical, and general anesthesia, on the development of POCD in patients undergoing cataract surgery.
Methods: Patients aged between 19-64 years who underwent cataract surgery were enrolled in this prospective observational study. All patients were assigned to one of three anesthesia groups: General (n=27), local (n=23), and topical (n=27). Cognitive status was assessed preoperatively and postoperatively (1st hour, 1st day, 1st week), using Blessed Orientation-Memory-Concentration (BOMC) test.
Results: Except age, the three anesthesia groups were similar in baseline patient characteristics and hemodynamic data (P>0.05). Age was significantly different between the groups: Patients in general anesthesia group were the youngest and those in local anesthesia group were the oldest (P<0.001). All postanesthetic BOMC scores in local and topical groups decreased compared to baseline values (P>0.05). However, the 1st hour BOMC score showed an insignificant increase in the general anesthesia group (P=0.554). Baseline mean BOMC score was higher in local anesthesia group than in other groups (P=0.037), whereas postoperative BOMC scores were similar between the three groups (P>0.05).
Conclusions: Local, topical, and general anesthesia had no different effects on postoperative cognitive functions in adult patients undergoing cataract surgery. There was also no statistical difference in postoperative BOMC scores between the three anesthesia methods.

Anahtar Kelimeler

Anesthesia, Cataract surgery, Postoperative cognitive dysfunction

Kaynakça

• 1. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006;102:1255-66.
• 2. Vatter H, Konczalla J, Seifert V. Endothelin related pathophysiology in cerebral vasospasm: what happens to the cerebral vessels? Acta Neurochir. 2011;110:177-80.
• 3. Casati A, Aldegheri G, Vinciguerra E, Marsan A, Fraschini G, Torri G. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol. 2003;20:640-6.
• 4. Li HT, Cao QJ, Qi XJ, Lu WL. Effect of anesthesia on cognitive status and MMP-2 expression in rats. Asian Pac J Trop Med. 2014;7:333-6.
• 5. Zywiel MG, Prabhu A, Perruccio AV, Gandhi R. The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res. 2014;472:1453-66.
• 6. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111:119-25.
• 7. Fathy W, Hussein M, Khalil H. Effect of local anesthesia (with lidocaine vs bupivacaine) on cognitive function in patients undergoing elective cataract surgery. Local Reg Anesth. 2019;12:1-6.
• 8. Karhunen U, Jönn G. A comparison of memory function following local and general anaesthesia for extraction of senile cataract. Acta Anaesthesiol Scand. 1982;26:291-6.
• 9. Campbell DN, Lim M, Muir MK, O'Sullivan G, Falcon M, Fison P, et al. A prospective randomised study of local versus general anaesthesia for cataract surgery. Anaesthesia. 1993;48:422-8.
• 10. Upadhyaya AK, Rajagopal M, Gale TM. The Six Item Cognitive Impairment Test (6-CIT) as a screening test for dementia: comparison with Mini-Mental State Examination (MMSE). Curr Aging Sci. 2010;3:138-42.
• 11. Kalem ŞA, Öktem Ö, Emre M. [Kısa Blessed Oryantasyon-Bellek-Konsantrasyon Test (BOMC) ve Standardize Mini Mental Test (SMMT) betimsel istatistik değerlerinin bir normal erişkin Türk örnekleminde saptanması]. In Turkish. Arch Neuropsychiatry. 2002;39:95-102.
• 12. Hole A, Terjesen T, Breivik H. Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand. 1980;24:279-87.
• 13. Jones MJ, Piggott SE, Vaughan RS, Bayer AJ, Newcombe RG, Twining TC, et al. Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement. BMJ. 1990;300:1683-7.
• 14. Mandal S, Basu M, Kirtania J, Sarbapalli D, Pal R, Kar S, et al. Impact of general versus epidural anesthesia on early postoperative cognitive dysfunction following hip and knee surgery. J Emerg Trauma Shock. 2011;4:23-8.
• 15. Davis N, Lee M, Lin AY, Lynch L, Monteleone M, Falzon L, et al. Postoperative cognitive function following general versus regional anesthesia, a systematic review. J Neurosurg Anesthesiol. 2014;26:369-76.
• 16. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of postoperative cognitive dysfunction and postoperative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22:67-79.
• 17. Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth. 2014;113:784-91.
• 18. Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: a narrative review of current clinical literature. BMC Anesthesiol. 2019;19:241.
• 19. Aranake-Chrisinger A, Cheng JZ, Muench MR, Tang R, Mickle A, Maybrier H, et al. Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study. BMJ Open. 2018;8:e017079.
• 20. Meineke M, Applegate RL, Rasmussen T, Anderson D, Azer S, Mehdizadeh A, et al. Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial. Med Gas Res. 2014;4:6.
• 21. Poorzamany Nejat Kermany M, Dahi M, Yamini Sharif R, Radpay B. Comparison of the effects of dexmedetomidine and remifentanil on cognition state after cataract surgery. Anesth Pain Med. 2016;6:e33448.
• 22. Berger M, Schenning KJ, Brown CH, Deiner SG, Whittington RA, Eckenhoff RG, et al. Best practices for postoperative brain health: recommendations from the fifth international perioperative neurotoxicity working group. Anesth Analg. 2018;127:1406-13.