Tolga GÜRSOY, Kemal Tolga SARAÇOĞLU, Pelin ÇOMAR DİNÇER, HALDUN AKOĞLU, Tümay UMUROĞLU

GERİATRİK HASTALARDA SEVOFLURAN-NİTRÖZ OKSİT İNHALASYON ANESTEZİSİ VE İNTRAVENÖZ PROPOFOL-REMİFENTANİL UYGULAMASI SONRASINDA ERKEN POSTOPERATİF NÖROKOGNİTİF FONKSİYONLARIN DEĞERLENDİRİLMESİ

Amaç: Yaşlı hastalarda majör cerrahi girişimler ve anestezi uygulamalarından sonra erken postoperatif dönemde deliryum, konfüzyon gibi kognitif bozukluklar görülebilmektedir. Bu çalışmanın amacı, nörokognitif yetersizlik gelişme açısından yüksek risk grubuna giren, laparotomi operasyonu geçirecek yaşlı hastalara uygulanacak iki farklı anestezi yönteminin karşılaştırılarak, hangi yöntemin daha düşük oranda nörokognitif yetersizliğe neden olduğunu saptamaktır. Yöntem: American Society of Anesthesiology (ASA) I-III sınıfı, 65 yaş üzeri, laparotomi operasyonu geçirecek 60 hasta çalışmaya dahil edildi. Hastalar randomize olarak 2 gruba (n=30) ayrıldı ve preoperatif mini mental test uygulandı. Anestezi indüksiyonu Grup ‹’de pentotal sodyum 3-5 mg kg-1 iv ile sağlandı. Anestezi %2 sevofluran, %67 N2O ve %33 O2 ile idame edildi. Grup T’de anestezi indüksiyonu propofol 3-6 mg kg-1 ve 1 µg kg-1 remifentanil iv ile sağlandı. Anestezi idamesinde, propofol ve remifentanil iv infüzyonu verildi, ventilasyonda %67 hava, %33 oksijen kullanıldı. Bulgular: Peroperatif dönemde, Grup T’nin ortalama arter basıncı değerleri postoperatif değerlerinden anlamlı olarak yüksekti (p

THE ASSESSMENT OF EARLY POSTOPERATIVE NEUROCOGNITIVE FUNCTIONS IN GERIATRIC PATIENTS FOLLOWING SEVOFLURANE-NITROUS OXIDE INHALATION ANESTHESIA AND INTRAVENOUS PROPOFOL-REMIFENTANIL

Objective: In the early postoperative period, cognitive disorders such as delirium or confusion may be seen in elderly patients following the procedures of major surgeries and anesthesia. We aimed to compare two different anesthesia methods in elderly patients undergoing laparotomy, since these patients are in high risk group concerning postoperative neurocognitive failure, and to assess which modality results in less postoperative neurocognitive failure. Method: Sixty patients over 65 years, with American Society of Anesthesiology (ASA) I-III, undergoing laparotomy, were included in the study and they were randomized into 2 groups (n=30). The day before the surgery, mini-mental tests were performed. In group I, general anesthesia was induced with thiopental 3-5 mg kg-1 iv. Anesthesia was maintained by 2% sevoflurane and 67% N2O in O2. In group T, propofol 3-6 mg kg-1 and remifentanil 1 µg kg-1 iv were used for induction. During maintenance; propofol and remifentanil infusions were administered with 67% air in oxygen. Results: In group T, preoperative mean arterial pressure measurements were significantly higher than the postoperative values (p0.05). Conclusion: We concluded that both sevoflurane-nitrous oxide and iv propofol-remifentanil anesthesia have equally deteriorating effects on postoperative short-term cognitive functions in elderly patients undergoing major surgical procedures.

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