Abstract
Objective: to improve the results of treatment in patients with concomitant cerebrovascular diseases, by reducing the incidence of postoperative delirium due to neuroprotective properties of sevoflurane. Subjects and methods. Eighty2two patients with concomitant dyscirculatory encephalopathy were examined. The goals of the study included evaluating (a) efficiency and safety of total intravenous anesthesia (TIVA) using propofol versus inhalational induction and (b) maintenance of anesthesia (IIMA) using sevoflurane in patients with atherosclerotic and hypertensive encephalopathy undergoing noncardiac surgery. Results. The patients from both groups were susceptible to episodes of unintentional cerebral desaturation (rSO2); however, only the TIVA group showed a high correlation between a decrease in rSO2 and increases in the blood levels of S100beta protein, a marker of neuronal damage, and in the incidence of postoperative delirium (r=0.7321; p=0.0000001) diagnosed in accordance to comprehensive clinical examination and MMSE scores. The IIMA group lacked a relationship of MMSE scores to the episodes of cerebral desaturation (r=0.1609; p=0.4860), which is regarded as a manifestation of the neuroprotective effect resulted from anesthetic preconditioning. Conclusion. sevafluran2based inhalational induction and maintenance of anesthesia in patients with atherosclerotic and hypertensive encephalopathy is preferable over intravenous anesthesia with propofol and fentanyl in patients with concomitatnt disregulatory enc encephalopathy. Key words: cerebral desaturation, postoperative delirium, anesthetic preconditioning, europrotection, sevoflurane.
Highlights
The patients from both groups were susceptible to episodes of unintentional cerebral desaturation; only the total intravenous anesthesia (TIVA) group showed a high correlation between a decrease in rSO2 and increases in the blood levels of S100beta protein, a marker of neuronal damage, and in the incidence of postoperative delirium (r=0.7321; p=0.0000001)
The IIMA group lacked a relationship of MMSE scores to the episodes of cerebral desaturation (r=0.1609; p=0.4860), which is regarded as a manifestation of the neu roprotective effect resulted from anesthetic preconditioning
Conclusion. sevafluran based inhalational induction and main tenance of anesthesia in patients with atherosclerotic and hypertensive encephalopathy is preferable over intravenous
Summary
Улучшить результаты лечения больных с сопутствующими цереброваскулярными заболевания ми за счет снижения частоты развития послеоперационного делирия путем использования нейропротекторных свойств севофлурана. В сравнительном аспекте рассматривается эффективность и безопасность использования тотальной внутривенной анестезии (ТВА) на основе пропофола и ингаляционной индукции и поддержания анесте зии на основе севофлурана (ИИПА) при обеспечении некардиохирургических операций у пациентов с атеросклеро тической и гипертонической энцефалопатией. Пациенты обеих групп подвержены эпизодам непреднамеренной це ребральной десатурации (rSO2), однако, только в группе больных ТВА отмечена высокая степень корреляционной зависимости между снижением rSO2, повышением в крови содержания маркера нейронального повреждения белка S100b и частотой развития послеоперационного делирия (r=0,7321; p=0,0000001), диагностируемого на основании комплексного клинического обследования и бальной оценки по шкале MMSE. Цель исследования — улучшить результаты лече ния больных с сопутствующими цереброваскулярными заболеваниями за счет снижения частоты развития по слеоперационного делирия путем использования ней ропротекторных свойств севофлурана
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