scholarly journals Effect of Preoperative Dexmedetomidine on Prevalence of Postoperative Cognitive Dysfunction in Elderly Patients Candidate for Orthopedic Surgery under General Anesthesia

2020 ◽  
Author(s):  
Alireza Pournajafian ◽  
Ali Khatibi ◽  
Mohammad Reza Ghodraty ◽  
Azadeh Emami ◽  
Mona Haji Aghajani
Keyword(s):  
Elderly Patients ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Normal Saline ◽  
Orthopedic Surgery ◽  
Postoperative Cognitive Dysfunction ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Double Blinded ◽  
State Examination

Background: Postoperative cognitive dysfunction (POCD) is amongst the most critical complications after surgery. This study shows the effect of dexmedetomidine on the prevalence of postoperative cognitive impairment. Methods: In this double-blinded clinical trial study, patients aged 60-80 years undergoing pelvic and femoral orthopedic surgery were randomly assigned in one of the two groups of the course, i.e., Dexmedetomidine (DEX) or normal saline (NS). We infuse One hour before anesthesia, one µg/kg dexmedetomidine in the group (DEX), and the same volume of normal saline (NS). Mini-Mental State Examination test (MMSE) was applied to evaluate the patients' cognitive condition, One day before the surgery, 24 and 72 hours after the surgery. Results: There was no significant difference between the two groups in terms of age, sex, duration of anesthesia, duration of surgery, and the amount of bleeding during operation (P>0.0). The postoperative hematocrit level was lower than the preoperative level in the group (DEX) (P<0.05). There was no significant difference in MMSE test scores pre and postoperatively between the two groups (P>0.05). Conclusion: Dexmedetomidine infused before surgery has no preventive effect on POCD in elderly patients undergoing pelvic and femoral orthopedic surgery under general anesthesia.

scholarly journals Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction

2015 ◽  
Vol 13 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Lívia Stocco Sanches Valentin ◽  
Ricardo Pietrobon ◽  
Wagner de Aguiar Junior ◽  
Ruth Pinto Camarão Rios ◽  
Mariane Galzerano Stahlberg ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Neuropsychological Test ◽  
Postoperative Cognitive Dysfunction ◽  
Test Battery ◽  
Cutoff Point ◽  
Neuropsychological Test Battery ◽  
State Examination

Objective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.

scholarly journals Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Roghayeh Ehsani ◽  
Soudabeh Djalali Motlagh ◽  
Behrooz Zaman ◽  
Saloumeh Sehat Kashani ◽  
Mohammad Reza Ghodraty
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
The Elderly ◽  
Academic Hospitals ◽  
The Impact ◽  
To Receive ◽  
State Examination ◽  
Trial Setting

Background: Postoperative cognitive dysfunction (POCD) and delirium are common in the elderly patients, given the controversial results of previous studies about the impact of anesthesia type on the occurrence of these complications. Objectives: This study was planned to compare the effects of general and spinal anesthesia on the prevalence of POCD and delirium. Methods: A single-blind non-randomized clinical trial. Setting was in two academic hospitals. Ninety-four patients over 50 years old scheduled for hip fracture fixation. Patients were divided into two groups to receive either general (GA) or spinal (SA) anesthesia. Both Mini-Mental State examination (MMSE) and Wechsler tests were used before the operation and 3 times postoperatively to assess the cognitive function and detect early POCD. The DSM-IV criteria were also used for the diagnosis of delirium. The incidence of delirium and POCD and their precipitating factors were compared between the two groups. Results: Ninety-four patients with a mean age of 67.12 years were studied. The overall prevalence of POCD and delirium was 17.02%; however, it was significantly higher in the GA group rather than the SA group, 29.7%, and 4.25%, respectively (P < 0.001). There was a significant relationship between age (P = 0.048), ASA class (P = 0.034), and educational level with the incidence of POCD, meaning that the probability of developing cognitive impairment decreases with patients’ higher level of education and lower ASA-physical status. Also, the rate of POCD in men was significantly higher than in women (P = 0.026). Conclusions: The finding of this study showed that, if there is no specific contraindication, neuraxial anesthesia may be preferred over general anesthesia in elderly patients.

scholarly journals Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

2013 ◽  
Vol 131 (6) ◽  
pp. 411-421 ◽  
Author(s):  
Fabiano Timbó Barbosa ◽  
Aldemar Araújo Castro ◽  
Célio Fernando de Sousa-Rodrigues
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Orthopedic Surgery ◽  
Postoperative Cognitive Dysfunction ◽  
Neuraxial Anesthesia ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Length Of Hospitalization

CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012), PubMed (1966 to November 2012), Lilacs (1982 to November 2012), SciELO, EMBASE (1974 to November 2012) and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.

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