scholarly journals Effect of regional anesthesia as a component of multimodal pain relief on the cognitive status of patients in ophthalmic surgery

2021 ◽  
Vol 15 (1) ◽  
pp. 49-56
Author(s):  
Ganna S. Dorofeeva ◽  
Yuriy Yu. Kobelyatskyy
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Postoperative Period ◽  
Cognitive Functions ◽  
Gas Flow ◽  
Initial Level ◽  
Cognitive Status ◽  
Ophthalmic Surgery ◽  
Group B ◽  
Group D

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty. MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment BatteryFAB) and a short scale for assessing mental status (Mini-Mental State ExaminationMMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevofluraneoxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively. RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups. CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p 0.05).

scholarly journals Cognitive deficit as a consequence of general anesthesia in ophthalmic surgery in postoperative patients

2021 ◽  
Vol 17 (1) ◽  
pp. 50-54
Author(s):  
G.S. Dorofeeva
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Gas Flow ◽  
Neuropsychological Testing ◽  
Cognitive Status ◽  
Pterygopalatine Fossa ◽  
Oxygen Mixture ◽  
Ophthalmic Surgery ◽  
Group B ◽  
Group D

This study considered the influence of the chosen method of analgesia on the state of cognitive functions in the postoperative period. Cognitive status analysis was performed using neuropsychological testing: Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE). The examination was performed in several stages: the day before surgery, 6 hours after it and on day 21 of the postoperative period. Patients were divided into two groups: group d received general anesthesia with the addition of dexmedetomidine for 40 minutes before surgery, anesthesia was maintained with sevoflurane-oxygen mixture on a small gas flow. In group b, the method of general anesthesia was supplemen­ted by the pterygopalatine fossa blockade for 20 minutes prior to the intervention. The groups were statistically comparable in terms of age and sex. Evaluation of the depth of analgesia was performed using analgesia nociception index, evaluation of the depth of anesthesia — with bispectral index. The result of the study showed that, according to neuropsychological testing on the MMSE and FAB, the indicators were more reduced in the postoperative period when using a combination of general anesthesia and the pterygopalatine fossa blockade than in the group received dexmedetomidine as a component of multimodal analgesia (p < 0.001). According to the examination after 6 hours of the postoperative period in group b, the MMSE indicators decreased by 20.8 %, the FAB — by 28.6 % from baseline. When analyzing the results in group d 6 hours after intervention, the indicators of cognitive status on the MMSE were below baseline by 8.3 %, on the FAB — by 13.3 %. Neuropsychological testing on day 21 using the MMSE and FAB showed recovery of cognitive function in both groups. Conclusion. Cognitive status in ophthalmic patients after penetrating keratoplasty according to the MMSE and FAB in both types of anesthesia differed significantly at the second stage of the study (in 6 hours), and over time (21 days after) differences between the groups of the pterygopalatine fossa blockade and of dexmedetomidine were insignificant (p > 0.05).

scholarly journals Analysis of the effect of dexmedetomidine combination with regional anesthesia on the cognitive state in the post-anesthesia period in ophthalmic surgery

2021 ◽  
Vol 17 (5) ◽  
pp. 74-78
Author(s):  
G.S. Dorofeeva
Keyword(s):  
Cognitive Dysfunction ◽  
Regional Anesthesia ◽  
Postoperative Period ◽  
Postoperative Cognitive Dysfunction ◽  
Pterygopalatine Fossa ◽  
Low Flow ◽  
Cognitive State ◽  
Short Term ◽  
Ophthalmic Surgery ◽  
Group D

Given a reduced cognitive reserve in patients in ophthalmic surgery, an anesthesiologist should pay special attention when choosing a method of anesthesia to prevent the development of postoperative cognitive dysfunction. The concept of multimodal anesthesia makes it possible to reduce the total number of narcotic analgesics and ataractics used intraoperatively while maintaining an adequate level of anesthesia and sedation, both intraoperatively and in the postoperative period. In ophthalmic surgery, regional anesthesia (pterygopalatine fossa blockade) is used before surgery in combination with infusion of dexmedetomidine. Materials and methods. The study was conducted at the premises of Dnipropet­rovsk Regional Clinical Ophthalmologic Hospital, 61 patients were examined after penetrating keratoplasty. The age of the subjects ranged from 18 to 60 years (mean age of 52.1 ± 2.0 years). Patients were randomized into two groups. Group d (n = 30) are patients who received anesthesia according to the following scheme: premedication for 40 min — infusion of dexmedetomidine, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously; induction — propofol 2–2.5 mg/kg fractionally until the onset of the clinical signs of anesthesia, fentanyl 0.005% 0.1 mg; relaxation on the background of atracurium besylate 0.3–0.6 mg/kg, tracheal intubation; maintenance of anesthesia: oxygen — sevoflurane mixture with FiO2 50–55 %, end-expired sevoflurane 1.4–1.8 vol.% (1–1.5 minimum alveolar concentration), use of low-flow technique. In the second group (db, n = 31), anesthesia was performed as in group d with the addition of pterygopalatine fossa blockade. Group d included 18 (60 %) men and 12 (40 %) women, mean age of 49.5 ± 2.5 years; db group — 16 (51.61 %) men and 15 (48.39 %) women (p = 0.583 according to the chi-square), mean age of 55.5 ± 3.2 years (p = 0.142 according to the t-test). Results. A comparative analysis of changes in cognitive status between db and d groups has shown no significant changes (p < 0.05) at different stages of neuropsychological testing. When considering the results of testing to assess short-term verbal memory in db and d groups, there was a 25 % decrease in the first 6 hours after surgery. After all, in d group, the indicators remained low compared to baseline until the 7th day of the postoperative period, while in the db group the recovery of short-term memory occurred one day after surgery. In both groups, the result of the Luria test on day 21 exceeded the baseline by 12.5 % in both groups. Examination using visual analogue scale has demonstrated that patients in db group felt better than those in d group. Conclusions. Thus, we see that the combination of dexmedetomidine with regional anesthesia in addition to less impact on the cognitive state improves the subjective well-being in the postoperative period in patients in ophthalmic surgery. Due to this, another link of influence on the etiological factors of postoperative cognitive dysfunction formation seems to appear.

Postoperative Oxygen Desaturation

2018 ◽  
pp. 153-157
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Postoperative Period ◽  
Respiratory Function ◽  
Continuous Monitoring ◽  
Oxygen Desaturation ◽  
Major Surgery ◽  
Continuous Administration ◽  
Transient Nature ◽  
Narcotic Analgesia

This case focuses on the benefits of using regional anesthesia vs. continuous administration of opioids by asking the question: What are the effects of regional anesthesia vs. continuous administration of opioids on respiratory function following general anesthesia for major surgery? This study demonstrated that narcotic analgesia is an important cause of oxygen desaturation and ventilatory disturbances during sleep in postoperative patients. The transient nature of desaturations and ventilatory disturbances highlighted the need for continuous monitoring techniques in the postoperative period.

scholarly journals FEATURES OF COGNITIVE STATUS OF OPHTHALMIC PATIENTS AS A PREDICTOR OF POSTOPERATIVE COGNITIVE DYSFUNCTIONS

World Science ◽  
2021 ◽  
Author(s):  
Dorofeeva A. S. ◽  
Kobelyatskyy Yu. Yu.
Keyword(s):  
Comparative Analysis ◽  
Postoperative Period ◽  
Bispectral Index ◽  
Cognitive Functions ◽  
Classical Method ◽  
Neuropsychological Testing ◽  
Multimodal Analgesia ◽  
Cognitive Status ◽  
Oxygen Mixture ◽  
Narcotic Analgesics

The influence of the chosen method of anesthesia on cognitive functions in the postoperative period is investigated in the article. Cognitive status analysis was performed using neuropsychological testing: Frontal Assessment Battery (FAB), short-term mental status assessment scale (Mini-MentalStateExamination - MMSE). The evaluation was performed in 3 stages: on the eve of surgery, 7 days after it and on the 21st day of the postoperative period. Patients were divided into two groups: group k - patients received general anesthesia with narcotic analgesics and benzodiazepines in premedication for 40 minutes, maintenance of anesthesia - sevoflurano - oxygen mixture on a low gas stream. minutes before surgery. Estimation of the depth of analgesia was monitored using ANI (Analgesia Nociception Index, index of analgesia with nociceptive effect), evaluation of the depth of sedation - by BIS (Bispectral index, Bispectral index). Patients in both groups were statistically comparable by gender and age. Given the comparative analysis of changes in neuropsychological testing on the FAB scale, the average in the group using dexmedetomidine increased by 13.3% relative to baseline. After a comparative analysis of neuropsychological testing on the MMSE scale, the indicators in the group using dexmedetomid while in the group with the "classical" method of anesthesia, they did not change significantly. Based on the data obtained, it can be argued that the use of dexmedetomidine, as a component of multimodal analgesia, has a positive effect on the state of cognitive functions in the post-anesthetic period.

scholarly journals A Comparison of Effectiveness f Betamethasone Gel and Lignocaine Jelly Applied to Tracheal Tube on Postoperative Sore Throat

2019 ◽  
Vol 13 (2) ◽  
pp. 58-61
Author(s):  
Muhammad Sazzad Hossain ◽  
Lipika Sanjowal ◽  
Md Afzalur Rahman ◽  
Mamunur Rashid ◽  
Mahiuddin Alamgir ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Sore Throat ◽  
Outer Surface ◽  
Postoperative Period ◽  
Lower Incidence ◽  
Postoperative Sore Throat ◽  
Significant Difference ◽  
Airway Symptoms ◽  
Group B ◽  
Comparison Of Effectiveness

Post-operative airway symptoms specially postoperative sore throat (POST) can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. Ninety ASA I and II informed consenting patients aged 20-50 years were recruited and randomly allocated into three groups of 30 each. The outer surface of the tracheal tubes used in intubating patients were lubricated with 0.05% betamethasone gel for group B, 2% lignocaine jelly for group L from the distal tip of the tube to the 15 cm mark and group C without lubrication. The incidence and severity of sore throat was then assessed at 1 hour, 6 hours and 24 hours during postoperative period. At 24 hours following extubation, there was a statistically significant lower incidence of POST in group B compared to other two groups. (group B= 6.66% vs group L= 33.33% vs group C= 40%, p<0.05). When the groups were compared in pairs, there was a statistically significant difference of POST between groups B and L also groups B and C with lower incidence of POST in group B at 24 hours, p<0.05. Significant difference in incidence of POST was, however, not found when group C was compared with group L separately, at different time of interval, p>0.05. It could be concluded that 0.05% betamethasone gel applied widely over endotracheal tube effectively reduces postoperative sore throat in comparison with 2% lignocaine jelly application. Faridpur Med. Coll. J. Jul 2018;13(2): 58-61

scholarly journals Pterygopalatine fossa block and dexmedetomidine as components of stress-limiting anesthesia in ophthalmic surgery

2021 ◽  
Vol 15 (1) ◽  
pp. 33-40
Author(s):  
Nadezhda V. Mynka ◽  
Yuriy Yu. Kobelyatskyy
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Postoperative Period ◽  
Corneal Transplantation ◽  
Pain Syndrome ◽  
Surgical Trauma ◽  
Ophthalmic Surgery ◽  
Anesthesia Group

BACKGROUND: To date, surgical interventions continue to be accompanied by a high proportion of complications and even death. In half of the cases, mortality and serious postoperative complications could have been prevented. After a comprehensive study of the factors affecting the prolongation of hospitalization and rehabilitation (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), surgical stress response was identified as the most significant inducer of dysfunction among various organs and systems. General anesthesia, in its classical sense, is not able to provide patients with complete protection against surgical trauma. Comprehensive protection can be obtained through a combination of general and local anesthesia and stress-protective drugs. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the proposed scheme of stress-limiting anesthesia in ophthalmic surgery patients with corneal transplantation. MATERIALS AND METHODS: This study provides a comparative characterization of the severity of the stress response and pain syndrome in patients operated under the conditions of classical general anesthesia (group K) and those who received the scheme of stress-limiting anesthesia (group DB). Multicomponent anesthesia was administered in both groups. Sibazone was used for sedation in group K, whereas dexmedetomidine was used in group DB. The patients in group DB underwent local anesthesia before surgery. The main criteria for assessing the results were as follows: hemodynamic stability, blood glucose, level of venous blood leukocytes, and severity of pain according to the VAS in the postoperative period. RESULTS: Both schemes helped avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. The analysis of blood glucose and leukocyte counts showed that patients in group K had a more significant deviation for both indicators from the preoperative level than those in group DB. In the study of pain syndrome, group K showed higher levels of pain according to the VAS than group DB. CONCLUSION: The scheme of stress-limiting anesthesia enables the control of postoperative pain without the additional use of narcotic analgesics and blockades in the postoperative period.

scholarly journals Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jizheng Zhang ◽  
Xiaohua Sun ◽  
Wenjie Cheng ◽  
Wanlu Ren
Keyword(s):  
General Anesthesia ◽  
Adverse Reactions ◽  
Anesthesia Induction ◽  
Intraoperative Hypotension ◽  
Extubation Time ◽  
Group A ◽  
T1 And T2 ◽  
Group B ◽  
Group D ◽  
Different Doses

Objective. To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods. A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018–January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 μg/kg, 0.5 μg/kg, and 0.8 μg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results. No notable differences in general data were observed among the groups ( P  > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B ( P  < 0.05), and the scores were higher in group D than those in group C ( P  < 0.05). The HR changes at each period were close between groups A and B ( P  > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D ( P  > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 ( P  < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B ( P  < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 ( P  < 0.05). With no statistical difference in the MAP levels at T0 among the four groups ( P  > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D ( P  < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D ( P  < 0.05), with longer extubation time in group B than that in groups C and D ( P  < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C ( P  < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B ( P  < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C ( P  < 0.05). Conclusion. Dexmedetomidine at doses of 0.5 μg/kg and 0.8 μg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 μg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 μg/kg.

Prevention of cognitive disorders in the postoperative period in preschoolers

2020 ◽  
Vol 15 (4) ◽  
pp. 92-99
Author(s):  
L.S. Zolotareva ◽  
◽  
O.N. Paponov ◽  
S.M. Stepanenko ◽  
A.V. Adler ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Cognitive Functions ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Disorders ◽  
Cognitive Outcomes ◽  
Control Group ◽  
Balanced Anesthesia ◽  
Key Words Anesthesia ◽  
Experimental Group

Surgeries under general anesthesia may result in reduced cognitive functions in children, which is important for child development Objective. To assess the incidence of cognitive disorders in children aged 3 to 7 years after intraoperative combined balanced anesthesia and to evaluate the efficacy of Cytoflavin in preventing them. Patients and methods. This study included 85 children who had undergone surgery (adenoidectomy and/or tonsillectomy) under general combined balanced anesthesia (sevoflurane, nitrous oxide, rocuronium bromide, fentanyl, and dexamethasone). The patients were randomized into two groups: control group (n = 40) and experimental group, in which children additionally received one infusion of cytoflavin intraoperatively (n = 44). All patients underwent comprehensive testing with the assessment of various cognitive functions before surgery, 24 hours postoperatively, and one month postoperatively. Results. Cognitive disorders were observed in 6%–10% of children after general anesthesia. The main manifestations of cognitive deficits in the postoperative period, such as impaired concentration, were most significant 24 hours postoperatively, but were eliminated one month later. A total of 7.1% of children demonstrated at least 20% decrease of their attention after surgery under general balanced anesthesia (confirmed by at least 3 tests). Six percent of children had a 20% decrease in their memory 24 hours postoperatively (confirmed by 2 tests). Cytoflavin improved cognitive performance 24 hours postoperatively, while patients in the control group had no significant changes. However, administration of cytoflavin had no significant impact on the incidence of cognitive deficit. Further studies are needed to identify children at risk who require prevention of cognitive disorders associated with anesthesia. Key words: anesthesia in children, anesthetics, pediatric surgery, cognitive outcomes, nicotinamide, postoperative cognitive dysfunction, cytoflavin

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

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