Yıl: 2020 Cilt: 26 Sayı: 1 Sayfa Aralığı: 30 - 36 Metin Dili: İngilizce DOI: 10.14744/tjtes.2019.04135 İndeks Tarihi: 10-11-2020

Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients

Öz:
BACKGROUND: Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response areadvantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesiawith epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with generalanesthesia (GA) would have a favorable influence on POCD prevention.METHODS: Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesiawas combined with GA. Patients’ cognitive function was assessed before and one week after surgery using a neuropsychological testbattery. POCD was defined as a drop of one standard deviation from baseline on two or more tests.RESULTS: A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups,except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p<0.001, respectively). The incidenceof POCD was comparable between groups (26% in GI and 24% in GII). Memory performance, visuospatial functions, and language skillstests were significantly higher in GII compared to GI.CONCLUSION: General anesthesia and epidural analgesia combined with general anesthesia resulted in similar POCD in elderlypatients undergoing abdominal surgery. However, in combined anesthesia group memory, language skills and visuospatial functionsappeared to be better preserved. Effective pain control might contribute to preventing cognitive decline in some domains.
Anahtar Kelime:

İleri yaş grubu hastalarda genel ve epidural anestezi ile yalnızca genel anestezi uygulamalarının nörokognitif fonksiyonlara etkilerinin karşılaştırılması

Öz:
AMAÇ: Ameliyat sonrası erken dönemde kognitif bozukluk yaşlı popülâsyonda sık görülür. Anestezi yönetimi ameliyat sonrası kognitif düşüşü etkileyebilir. Etkin analjezi, erken derlenme ve stres yanıtın modülasyonu nöroaksiyel blokların avantajlarıdır. Bu çalışmanın amacı, genel anestezi ve epidural analjezi ile kombine edilen genel anestezinin postoperatif kognitif bozukluk (PKB) için etkisini karşılaştırmaktır. Hipotezimiz genel anestezi (GA) ile birlikte nöroaksiyel bloğun, PKB önlenmesinde olumlu bir etkisi olacağıydı. GEREÇ VE YÖNTEM: Kalp cerrahisi dışında operasyona gelen 60 yaşın üstündeki hastalar bu ileriye yönelik randomize çalışmaya dâhil edildi ve hastalar iki gruba ayrıldı. Birinci gruptaki hastalara (GI) GA uygulandı; ikinci grupta (GII) ise epidural analjezi ile GA kombine edildi. Hastaların kognitif fonksiyonları, nöropsikolojik test bataryası kullanılarak ameliyattan bir hafta önce ve bir hafta sonra değerlendirildi. PKD, iki veya daha fazla testte bazal değerden bir standart sapma düşüş olarak tanımlandı. BULGULAR: Çalışmayı toplam 116 hasta tamamladı. GI’de GII’den anlamlı olarak yüksek olan maksimum ağrı skorları hariç (sırasıyla, 4.9±2.8’e karşılık 1.7±1.7; p<0.001) demografik ve operatif veriler gruplar arasında benzerdi. PKD insidansında gruplar arasında fark saptanmadı (GI’de %26 ve GII’de %24). Bellek performansı, görsel mekânsal fonksiyonlar ve dil beceri testleri GII’de GI’e göre anlamlı olarak yüksek bulundu. TARTIŞMA: Genel anestezi ve genel anestezi ile kombine epidural analjezi, abdominal cerrahi geçiren yaşlı hastalarda benzer PKD insidansı ile sonuçlandı. Bununla birlikte, kombine anestezi grubunda hafıza, dil becerileri ve görsel mekânsal fonksiyonların daha iyi korunduğu görüldü. Etkin ağrı kontrolü bazı alanlarda kognitif işlevlerin korunmasında katkı sağlayabilir durmaktadır
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA orhun g, SUNGUR Z, KOLTKA A, SAVRAN KARADENİZ M, YAVRU H, Gürvit H, ŞENTÜRK N (2020). Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. , 30 - 36. 10.14744/tjtes.2019.04135
Chicago orhun günseli,SUNGUR Zerrin,KOLTKA Ahmet Kemalettin,SAVRAN KARADENİZ Meltem,YAVRU Hacer Ayşen,Gürvit Hakan,ŞENTÜRK N. Mert Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. (2020): 30 - 36. 10.14744/tjtes.2019.04135
MLA orhun günseli,SUNGUR Zerrin,KOLTKA Ahmet Kemalettin,SAVRAN KARADENİZ Meltem,YAVRU Hacer Ayşen,Gürvit Hakan,ŞENTÜRK N. Mert Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. , 2020, ss.30 - 36. 10.14744/tjtes.2019.04135
AMA orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. . 2020; 30 - 36. 10.14744/tjtes.2019.04135
Vancouver orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. . 2020; 30 - 36. 10.14744/tjtes.2019.04135
IEEE orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N "Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients." , ss.30 - 36, 2020. 10.14744/tjtes.2019.04135
ISNAD orhun, günseli vd. "Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients". (2020), 30-36. https://doi.org/10.14744/tjtes.2019.04135
APA orhun g, SUNGUR Z, KOLTKA A, SAVRAN KARADENİZ M, YAVRU H, Gürvit H, ŞENTÜRK N (2020). Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulusal Travma ve Acil Cerrahi Dergisi, 26(1), 30 - 36. 10.14744/tjtes.2019.04135
Chicago orhun günseli,SUNGUR Zerrin,KOLTKA Ahmet Kemalettin,SAVRAN KARADENİZ Meltem,YAVRU Hacer Ayşen,Gürvit Hakan,ŞENTÜRK N. Mert Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.1 (2020): 30 - 36. 10.14744/tjtes.2019.04135
MLA orhun günseli,SUNGUR Zerrin,KOLTKA Ahmet Kemalettin,SAVRAN KARADENİZ Meltem,YAVRU Hacer Ayşen,Gürvit Hakan,ŞENTÜRK N. Mert Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.1, 2020, ss.30 - 36. 10.14744/tjtes.2019.04135
AMA orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 30 - 36. 10.14744/tjtes.2019.04135
Vancouver orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 30 - 36. 10.14744/tjtes.2019.04135
IEEE orhun g,SUNGUR Z,KOLTKA A,SAVRAN KARADENİZ M,YAVRU H,Gürvit H,ŞENTÜRK N "Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.30 - 36, 2020. 10.14744/tjtes.2019.04135
ISNAD orhun, günseli vd. "Comparison of epidural analgesia combined with general anesthesia and general anesthesia for postoperative cognitive dysfunction in elderly patients". Ulusal Travma ve Acil Cerrahi Dergisi 26/1 (2020), 30-36. https://doi.org/10.14744/tjtes.2019.04135