Abstract
The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.
Highlights
The modern concept of anesthetic support aims to provide adequate pain relief, and to control all the patient’s vital functions during the operation
It should be noted that patients in both groups showed an intraoperative decrease in hemodynamic parameters compared to the baseline, which is explained by the effect of general anes
The study results showed that rSO2 was significantly decreased during the CD insufflation as compared to before premedication: in LH – by 7.0 % (p
Summary
The modern concept of anesthetic support aims to provide adequate pain relief, and to control all the patient’s vital functions during the operation. It should be noted that in the last decade, the concern about the adverse effect of general anesthesia on the elderly patients’ brain has been growing, since these surgical patients often have postoperative cognitive dysfunction, which in turn can cause an increase in morbidity and mortality [1]. One of the most important tasks of modern anesthesiology is to objectify the general anesthesia monitoring, which provides for the control of functions and processes, identifying their dangerous abnormalities to prevent complications during anesthesia. According (2020), «EUREKA: Health Sciences» Number 4 to statistics, the most frequent complications in the process of anesthesia are various hypoxic conditions of the brain, which often cause POCD, especially in elderly and senile patients [2, 3]
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