Impairment of higher mental functions after laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane

Author(s):  
M.I. Neimark ◽  
V.V. Shmelev ◽  
A.A. Rakhmonov ◽  
E.A. Nazarchuk
2020 ◽  
Vol 17 (5) ◽  
pp. 15-24
Author(s):  
M. I. Neymark ◽  
V. V. Shmelyov ◽  
Z. A. Titova ◽  
S. A. Khaustova ◽  
B. A. Shadymov

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.


2019 ◽  
Vol 26 (2) ◽  
pp. 274-286
Author(s):  
Bella Kotik-Friedgut ◽  
Alfredo Ardila

Luria has long been one of the most influential authors in cognitive neurosciences, in particular in neuropsychology. New scientific advances and clinical observations have confirmed many of his proposals and hypotheses. In this paper one of his major ideas is analyzed: the influence of cultural factors on human cognition. The systemic-dynamic Lurian analysis of brain activity is based on Vygotsky's concept of higher mental functions, which are social in origin and complex and dynamic in their structure. Higher mental functions are based on a complex system of operations and means both external and internal. Living conditions and hence cultural characteristics have dramatically changed during the last half century with the development of new media and new virtual ways of communication. Review of contemporary developments supporting the appropriateness and usefulness of these concepts is presented. It is finally concluded that Luria is one of the major founders of contemporary neuropsychology not only from the clinical point of view, but also from the cultural perspective. His influence has continued undiminished during the 21st century.


2018 ◽  
Vol 12 (3) ◽  
pp. 321-325 ◽  
Author(s):  
Eliasz Engelhardt

Abstract The debates about the mind and its higher functions, and attempts to locate them in the body, have represented a subject of interest of innumerable sages since ancient times. The doubt concerning the part of the body that housed these functions, the heart (cardiocentric doctrine) or the brain (cephalocentric doctrine), drove the search. The Egyptians, millennia ago, held a cardiocentric view. A very long time later, ancient Greek scholars took up the theme anew, but remained undecided between the heart and the brain, a controversy that lasted for centuries. The cephalocentric view prevailed, and a new inquiry ensued about the location of these functions within the brain, the ventricles or the nervous tissue, which also continued for centuries. The latter localization, although initially inaccurate, gained traction. However, it represented only a beginning, as further studies in the centuries that followed revealed more precise definitions and localizations of the higher mental functions.


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