Cemil GÜLÜCÜ, Ali Abbas YILMAZ, Saban YALÇIN, Özlem Selvi CAN, Sacide DEMİRALP, Neslihan ALKIŞ

Geriatrik hastalarda intravezöz ve epidural morfin ile hasta kontrolü analjezi uygulamasının kognitif fonksiyonlar üzerine etkisi

Amaç: Postoperatif kognitif bozukluk; hafıza ve konsantrasyonda bozuklukla karakterize, özellikle major cerrahi ameliyat geçiren yaşlı hastalarda, oldukça sık görülen bir durumdur. Yaşlılarda postoperatif deliryum oluşması, artmış morbidite, gecikmiş fonksiyonel derlenme ve hastanede kalış süresinde uzamaya neden olur. Bu çalışmada; genel anestezi altında radikal ve radikal olmayan prostatektomi yapılan geriatrik hastalarda postoperatif ağrı kontrolü için hasta kontrollü epidural analjezi (HKAE) veya hasta kontrollü intravenöz analjezi (HKAI) yöntemi uygulamasının kognitif fonksiyonlar üzerine etkisi karşılaştırıldı. Metod: Çalışmaya elektif radikal ve radikal olmayan prostatektomi operasyonu için genel anestezisi planlanan 65 yaş üstü ASA I-III sınıfında toplam 40 hasta dâhil edildi. Hastalar Grup İ (İntravenöz HKA n=20) ve Grup E (Epidural HKA n-20) olmak üzere rastgele 2 gruba ayrıldı. Preoperatif ve postoperatif 24-48. ^saatlerde Mini Mental Durum Testi (MMST) uygulandı ve skorları kaydedildi. Postoperatif yoğun bakım ünitesine (PYBÜ) alındıktan sonraki 2., 4., 6., 12., 24., 48., saatlerde; hemodinamik veriler, görsel analog skala (VAS), sayısal derecelendirme skala (NRS), gözlemci ağrı skalası, gözlemci sedasyon skoru, komplikasyonlar, HKA cihazından istek (demand)/sunum (delivery) değerleri ve ek analjezik ihtiyacı kaydedildi. Bulgular: Gruplar arasında postoperatif tüm ölçümlerde istirahat ve aktivite VAS ve NRS değerleri açısından fark saptanmadı. Preoperatif MMST skoru, postoperatif 24. saatte başlangıç değerine göre artmış bulundu. Bu artış her iki grup için hem başlangıca göre hem de bir önceki ölçüme göre anlamlı olmasına karşılık (p

The effects of patient controlled analgesia methods with intravenous and epidural morphine on cognitive functions in geriatric patients

Objective: Postoperative cognitive dysfunction characterized with decline in memory and concentration is a very common situation particularly in elderly patient with major surgery. Postoperative delirium in elderly patients caused to increased morbidity, delayed functional recovery and increased hospital stay. The aim of this study is to compare the effects of intravenous or epidural patient controlled analgesia method on cognitive functions in elderly radical or non- radical prostathectomy patients. Methods: 40 ASA I-III patients over 65 years old scheduled for radical or non-radical prostathectomy with general anesthesia included the study. Patients were randomized to two groups; Group I (intravenous patient controlled analgesia, PCAI n=20) and Group E (epidural patient controlled analgesia, PCAE n=20). Mini Mental Status Test (MMST) were asked at preoperatively, postopeatively 24th and 48"' hour. Postoperative intensive care unit 2"', 4"', 6th, 12"', 24"', 48th hour hemodynamic parameters, Visual Analog Scale (VAS), Numeric Rating Scale (NRS), observed pain scale, observed sedation score, complications, PC A demand and delivery numbers and additional analgesic need were recorded. Results: There were no difference between groups at resting and active VAS and NRS values at all postoperative measurements. Postoperative 24"' MMST score was higher in all groups when compared with baseline. This increase was significant when compared baseline and previous measurement (p<0.001), but was not significant betweeen groups (p=0.54). Conclusion: Postoperative PCAI and PCAE methods provide adequate analgesia and preserve cognitive functions in elderly patients.

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