Abstract
To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases.
Highlights
Post-operative cognitive dysfunction (POCD) is a shortterm decline of cognitive function that has been increasingly recognized as a central nervous system complication occurring after major or emergency surgery, especially inBrain activation reduces the balance between cerebral consumption of oxygen and carbohydrate in terms of African Health Sciences Vol 16 Issue 4, December, 2016 the cerebral oxygen–carbohydrate index (OCI)[9], which is a ratio determined by the cerebral uptake of oxygen compared with that of carbohydrate[10,11,12,13]
Since elderly patients often have various degrees of heart diseases, maintenance of a balance of stable hemodynamics and myocardial oxygen supply and demand is important for preventing the occurrence of POCD37, . 38,39 In the present study, we investigated the effects of hemodynamic stability induced by nicardipine and nitroglycerin and their pairwise combination with esmolol on POCD in elderly patients after radio-frequency ablation of atrial fibrillation
We found that multivariate logistic regression analysis showed significant associations between the incidence of POCD and drug regimens in Groups A and B, which had the lowest incidences of POCD, thereby suggesting that nicardipine alone or in combination with esmolol issuperior to nitroglycerin alone or in combination with esmolol in minimizing the incidence of POCD
Summary
Post-operative cognitive dysfunction (POCD) is a shortterm decline of cognitive function that has been increasingly recognized as a central nervous system complication occurring after major or emergency surgery, especially inBrain activation reduces the balance between cerebral consumption of oxygen and carbohydrate in terms of African Health Sciences Vol 16 Issue 4, December, 2016 the cerebral oxygen–carbohydrate index (OCI)[9], which is a ratio determined by the cerebral uptake of oxygen compared with that of carbohydrate[10,11,12,13]. Post-operative cognitive dysfunction (POCD) is a shortterm decline of cognitive function that has been increasingly recognized as a central nervous system complication occurring after major or emergency surgery, especially in. Li et al.[19] found that treatment with calcium channel antagonists may protect against neuronal damage, improve cognitive function, and delay cognitive dysfunction. Calcium channel antagonists have been found to influence cerebral metabolism, and beta-receptor blockers have been shown to have no effect on OCI16,20,21. Several studies have shown that the uptake of lactate and glucose reduces OCI22,23. It remains to be determined whether calcium channel blockers and beta-receptor blockers affect early POCD in elderly patients after surgery
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