Seda Banu AKINCI, Halide CEYHAN, Zeynep COŞKUN, MELİH AKINCI, Saadet ÖZGEN

Günübirlik anestezi sonrası kognitif yetmezlik sorgulaması

Genel anestezi sonrası kognitif yeteneklerin azalması, günübirlik cerrahi sonrasında eve gönderilen hastalarda tehlikeli olabilir. Bu çalışmada günübirlik genel anestezi sonrası ilk üç gün içinde hastalarda rastlanan kognitif yetmezlik semptomlarının halotan, isofloran, sevofloran ve propofol anestezisi sonrası karşılaştırılması amaçlanmıştır. Etik kurul izni ve hasta oluru alındıktan sonra, günübirlik anestezi alarak sistoskopi yapılması planlanan, 60 yaşından büyük 100 hasta çalışmaya dahil edildi. Hastalardan operasyon öncesi üç gün içinde yaşadıkları kognitif yetersizlikleri skorladıkları preoperatif Kognitif Yetmezlik Sorgulamasını doldurmaları istendi. Propofol ve alfentanil ile anestezi indüksiyonundan sonra N2O 'ya ek olarak kullanılan idame anestezik ajanın cinsine göre hastalar rastgele dört gruba ayrıldılar: Halotan, izofluran, sevofluran ve propofol infüzyon grupları. Anestezisi sona erip derlenme odasına alınan hastalara; eve gönderilmeden önce, ameliyattan sonraki üçüncü günde doldurmaları istenerek üzerinde adres ve pul olan ikinci bir kognitif yetmezlik sorgulaması formu verildi. Verilerin değerlendirilmesinde Ki-Kare, Wilcoxon rank testi ve Kruskal-Wallis testleri kullanıldı. Çalışmamıza dahil olan 100 hastadan gelen 58 geçerli cevaba göre; %50 hastada anestezi sonrası ilk üç gün içinde, anestezi öncesine göre daha fazla kognitif yetmezlik olduğu görüldü (p

Anahtar Kelimeler:

İzofluran, Kavrayış bozuklukları, Anestezikler, genel, Anestezi, genel, Ameliyat sonrası komplikasyonlar, Halotan, Propofol

Cognitive dysfunction after ambulatory anesthesia

Cognitive dysfunction after general anesthesia may be very dangerous for the patient who is sent home after ambulatory surgery. The purpose of this study is to compare the cognitive failures after halotane, isoflurane, sevoflurane and propofol infusion anesthesias after day-case cystoscopies. After ethical committee approval and patients' consents, 100 patients scheduled for day-case cystoscopic surgery were included into this study. Patients were asked to complete the Cognitive Failure Questionnaire (CFQ), a standard measure of performance of everyday tasks, with respect to the 3 days before admission. Patients were randomised to four groups according to the maintenance agent after the same induction with propofol and alfentanyl: Halothane +N2O, isoflurane +N2O, sevoflurane +N2O, propofol infusion +N2O. Patients took home a second CFQ in a prepaid envelope to complete it 3 days after anesthesia. Chi-square, Wilcoxon rank test and Kruskal-Wallis tests were used for analysis. Fifty percent of the 58 respondents had worse CFQ scores after anesthesia when compared with the preoperative scores (p<0.05). No difference between the different maintenance agents was found regarding the change in CFQ scores after anesthesia. The cognitive dysfunction were similar after halotane, isoflurane, sevoflurane and propofol infusion anesthesias. It was concluded that, whatever the maintenance agent is, patients should be informed about the possible cognitive failures after ambulatory general anesthesia.

Keywords:

Isoflurane, Cognition Disorders, Anesthetics, General, Anesthesia, General, Postoperative Complications, Halothane, Propofol,

PDF

___

1. Tzabar et al. Cognitive failures after general anaesthesia for day-case surgery. Br J Anaesth 1996;76:194-7
2. Storms LH, Stark AH, Calvcrley RK, Symitli NT. Psychological functioning after halolhane or enfluranc anesthesia. Ancsth Anulg 1980:59:245-9
3. Dodds C, Allison J. Postoperative cognitive defisit in the elderly surgical patient. Br J Anaeslh 1998;S1:449-62
4. Davidson LA, Steinhelber JC, Eger El, Stevens WC. Psychological effects of halothane and isofluranc anesthesia. Aneslhcsiology 1975;43(3):3l3-24
5. Broadbent et al. The cognitive failures questionnaire (CFQ) and its correlates. Br J Clin Psychol 19S2;21:l-16
6. Yogendran, Simtheralingdam, Asokumar et al. A prospective Randomised Double-Blinded Study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995;S0(4):682-6
7. Smurthwaite GJ, Ghaly RG. Follow up of daycase patients in a district general hospital. Br J Anaesth 1993; 71(2):310-l
8. Herbert M, Mealy TEJ, Bourke JB, Fletcher İR, Rose JM. Profile of recovery after general anaesthesia. Br Med J 1983; 286:1539-42
9. Williams et al.Cognitİve effects after epidural vs general anesthesia in older adults. JAMA 1995;274:44-50
10. Chung F, Meier R, Lautenschlager E, Carmichael FJ, Chung A. General or spinal anaesthesia. Anesthesiology 1987:67:422-7
11. Rhyanen p, Helkala EL, Ihalainen O, et al. Effects of anesthesia on the psychological function of patients. Ann Clin Res 1978:10:318-22
12. Hendley B, Laurence AS. Infusion or inhalational anaesthesia for day-case cysloscopy. BJA 1994;73(5}:711-2
13. Smith SO, Lowrie A, Martlew R, Laurence AS. Does choice of day-case anaesthetic affect postoperative morbidity? BJA 1993;71(5):769-70
14. Kalman SH, Jensen AG, Ekberg K, Eintrel C. Early and late recovery after major abdominal surgery . Comparison between propofol anesthesia with and without nitrous oxide and isoflorane anaesthesia, Acta Anaesthesiol Scand 1993:37:730-6
15. Chen X, Zhao M, White Pf, Li S, et al, The recovery of cognitive function after general anesthesia in elderly patients: A comparison of desfiurane and sevoflurane.Anesth Analg 2001:93:1486-94
16. Smith RJ, Roberts NM, Rodgers RJ, Bennett S. Adverse cognitive effects of general anaesthesia in young and elderly patients. Int Clin Psychopharmacol l986;l:253-9
17. Smith C, Carter M, Sebel P, Yate P. Mental function for general anaesthesia for transurethral procedures. BJA 1991 ;67:262-8
18. Moller JT, Cluitmans P, Rasussen LS et al. Prolonged postoperative cognitive dysfunction in the elderly. Lancet 199S;351:857-61