Sulbutiyaminin yaşlı hastalarda postoperatif derlenme dönemi ve kognitif fonksiyonlara etkisi

Amaç: Geriyatrik hastalarda preoperatif sulbutiyamin kullanımının uyanma süresi, uyku uyanıklık siklusu ve kognitif fonksi¬yonlara olan etkisini araştırmaktır. Yöntem: Çalışmamız ASA I-II, elektif periferik cerrahi geçirecek, 60 yaş ve üzeri toplam 40 hasta ile yapıldı. Hastalar rasgele yöntemle kontrol (n=20) ve ilaç (n=20) olmak üzere 2 gruba ayrıldı. İlaç grubundaki hastalara operasyon öncesi 14 gün süreyle sulbutiyamin 200 mg peroral günde iki kez olmak üzere verildi. Preoperatif sulbutiyamin verilen ilaç grubu ve verilmeyen kontrol gruplarındaki hastalar uyanma süreleri, taburcu olma skoru (Aldrete), postoperatif kognitif fonksiyonlar (standart mini mental test skoru) ve uyku uyanıklık siklusundaki değişiklikler açısından karşılaştırıldı. Elde edilen bulgular Student's t, ki-kare ve Mann-Whitney U testleri ile istatistiksel olarak karşılaştırıldı. Bulgular: İlaç grubunda uyanma ve derlenme süreleri belirgin olarak kısa bulundu (p

The effect of sulbutiamine on postoperative recovery and cognitive functions in geriatric patients

Objective: To investigate the effects of preoperative sulbutiamine administration on recovery time, sleep-conciousness cycle, and cognitive functions in geriatric patients. Method: Forty patients, ASA group I-II, above 60 years of age and scheduled for elective peripheral surgery were enrolled in this study. Patients were randomly assigned to control (n=20) and sulbutiamine (n-20) groups. 200 mg of sulbutiamine was administred peroral twice a day for 14 days prior to surgery. Recovery time, Aldrete scores, postoperative cognitive functions (standard mini mental test scores) and sleep-consciousness cycle abnormalities were recorded and compared statistically using Student's t-test, ki-square and Mann-Whitney U tests. Results: Recovery time was significantly shorter in the sulbutiamine group compared to the control group (p<0.01). The incidence of sleep-conciousness cycle abnormalities during postoperative days 1 and 2 was higher in the control group than in the sulbutiamine group (p<0.05). While mini mental test scores were similar in the preoperative period, they were significantly higher in the drug group at 1,2 and 4. hours after the operation and at the postoperative day 1 (p<0.01). Aldrete scores in the sulbutiamine treated group were significantly higher at 5,10 and 15 minutes postoperative (p<0.01) Conclusion: Preoperative administration of sulbutiamine in geriatric patients shortened time to regain consciousness and improved postoperative cognitive functions.

Kaynakça

1. Berggren D, Gustafson Y, Eriksson B, ve ark. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg 1987; 66: 497-504.

2. Muravchick S. Immediate and long term nervous system effects of anesthesia in elderly patients. Clin Anesthesiology 1986; 4: 1035-45.

3. Neilson WR, Gelb AW, Casey JE, ve ark. Long term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly. Anesthesiology 1990; 73: 1103-9.

4. Loo H, Poirier MF, OUat H, Elatki S. Effects of sulbitiamine on psychobehavioral inhibition in major depressive episodes. Encephale 2000; 26 (2): 70-5.

5. Mesulam MM, Mufson EJ, Wainer BH, Levey AI. Central cholinergic pathways in the rats: An overview based on an alternative nomenclature. Neuroscience 1983; 10: 1185-201.

6. McLeskey C. Anesthesia for the geriatric patient. Advances in Anesthesia, Volume 2 Stoelting K, Barash G, Gallagher J. Year Book Medical Publisher 1985; 31-68.

7. Casati A, Aldegheri G, Vinciguerra E, Marsan A, Fraschini G, Torri G. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol 2003; 20 (8): 640-6.

8. Dahn J, Eckert S, Oster M, ve ark. Cognitive functions and cerebral oxygenatioli of older patients after general and regional anaesthesia. Anaesthesist 2003; 52 (7): 596-605.

9. Dahn J, Oster M, Molter A, ve ark. Anesthesia in geriatric patients. The determination of physiological variables for cognitive function in geriatric patients after regional or general anesthesia. Anaesthesist 1999; 48 (6): 379-86.

10. Gabutta A, Farina P, Cogorno P, ve ark. Neuropsychologic effects of anesthesia in the elderly. Minerva Anesthesiol 1992; 58 (9): 535-42.

11. Haan J, van Kleef JW, Bloem BR, ve ark. Cognitive function after spinal or general anesthesia for transurethral prostatectomy in elderly men. J Am Geriatr Soc 1991; 39 (6): 596-600.

12. Chung FF, Chung A, Meier RH, ve ark. Comparison of perioperative mental function after general anesthesia and spinal anesthesia with intravenous sedation. Can J Anaesth 1986; 36: 382-7.

13. Williams RP, Urquhart BL, Sharrock NE, ve ark. Postoperative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992; 40: 759-67.

14. Balzamo E, Vuillon-Cacciutolo G. Facilitation of a state of wake fulness by semi-chronic treatment with sulbutiamin (Arcalion) in Macaca Mulatta. Neurophysiol Clin 1982; 12 (4): 373-8.

15. Yoshimura K, Nishibe Y, Inoue Y, ve ark. Animal experiments on thiamine avitaminosis and cerebral function. J Nutr Sci Vitaminol 1976; 22: 429-37.

16. Van Reeth O, Zhang Y, Zee PC, ve ark. Aging alters the feedback effects of the activity-rest cycle on the circadian clock. Am J Physiol 1992; 263: 981-6.

17. Van Reeth O, Zhang Y, Zee PC, ve ark. The effects of aging on the entraining properties of activity-inducing stimuli on the circadian clock. Brain Res 1993; 607: 286-92.

18. Geokas MC, Lakatta EG, Makinodan T, ve ark. The aging process. Ann Int Med 1990; 113: 455-66.

19. Thompson TL, Moran MG, Neis AS. Psychotropic drug use in the elderly. N Eng J Med 1983; 308 (3): 134-8.

20. Tune LE, Holland A, Folstein MF. Association of postoperative delirium with raised serum levels of anticholinergic drugs. Lancet 1982;2:651-3.

21. Mclntosh TK, Bush HL, Yeston NS. Beta endorphin, cortisol and postoperative delirium: a preliminary report. Psychoneuroendocrinology 1985; 10: 303-13.

22. Vander Mast RC, Fekkes D, Moleman P, ve ark. Is postoperative delirium related to reduced plasma tryptophan? Lancet 1991; 38: 851-2.

23. Ngai SH, Cheney DL, Fink AD. Acetylcholine concentrations and turnover in rat brain structures during anesthesia with halothane, enflurane and ketamine. Anesthesiology 1978; 48:4-7.

24. Cryns AG, Gorey KM, Goldstein MZ. Effects of surgery on the mental status of older persons. A metaanalytic review. J Geriatr Psychiatry Neurol 1990; 3: 184-91.

25. Michaeu J, Durkin TP, Destrade T, Rolland Y, Jaffard R. Chronic administration of sulbutiamine improves long term memory formation in mice: possible cholinergic formation. Pharmacol Biochem Behav 1985; 23: 195-8.

26. Vander WC, Johnson JC, Spoerlein MT, ve ark. The effect of thiamine deficiency on the actions of drugs effecting the central nervous system. Chem Pathol Pharmacol 1973; 6 (2): 513-25.

27. Trovero F, Gobbi M, Weil-Fuggaza J, ve ark. Evidence for a modulatory effect of sulbutiamine on glutamatergic and dopaminergic cortical transmissions in the rat brain. Neuroscience Letters 2000; 292: 49-53.

28. Folstein MF, Folstein SE, McHugh P. "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-98.

29. Inouye SK, van Dyck CH, Alessi CA. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med 1990; 113: 941-8.

30. Anthony JC, LeResche L, Niaz U. Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients. Psychol Med 1982; 12: 397-408.

Kaynak Göster

  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Hira Gizem Fidan

4.6b 3.3b

Sayıdaki Diğer Makaleler

Sulbutiyaminin yaşlı hastalarda postoperatif derlenme dönemi ve kognitif fonksiyonlara etkisi

F. Banu İŞLER, İ. Varlık DOĞAN, Binnaz AY, Tümay UMUROĞLU, F. Yılmaz GÖĞÜŞ

İntraoperatif akciğer ödemi (Olgu sunumu)

Hülya YAZICIOĞLU, Yavuz KAYA, Özcan ERDEMLİ

Tiroidektomi sonrası entübasyon gerektiren stridor (Olgu sunumu)

Melis GÖKÇE, Berrin GÜNAYDIN, Yener KARADENİZLİ

Hellp sendromu ve spinal anestezi (Olgu sunumu)

Semra KARAMAN, İLKBEN GÜNÜŞEN, Vicdan FIRAT

Total kalça protezi cerrahisinde hasta kontrollü rejyonal analjezi: Psoas kompartman ve üçlü femoral sinir blokajının karşılaştırılması

MENŞURE KAYA, Gülçin ÖZALP, Gonca TUNCEL, Özgür CANOLER, Sanem TURGUT, Serpil ŞAVLI, Nihal KADIOĞULLARI

Transplante karaciğerde diltiazem kan akımını etkileyebilir mi? Erken sonuçlarımız

ADNAN TORGAY, İclal IŞIKLAR, Arash PİRAT, Selim CANDAN, Gülnaz ARSLAN, Mehmet HABERAL

Laparotomilerde farklı remifentanil dozlarının hemodinami ve derlenme üzerine etkileri

NECMİYE HADİMİOĞLU, Suat SANLI, Özsan ÖZGÜREL, AYŞE GÜLBİN ARICI, Arif YEĞİN

Pediyatrik kalp cerrahisinde kaudal blok uygulaması ile erken ekstübasyon

Elif A. AKPEK, Sevim BALTALI, Aslı DÖNMEZ, Şükrü MERCAN

Konjenital bilateral mandibular hipoplazi ve hava yolu yönetimi (Olgu sunumu)

Yavuz GÜRSOY, Hülya KORKMAZ, Ayşe KARCI, Yücel MOL

Desfluran ve sevofluranın derlenme sürelerinin bispektral indeks değerleri ile karşılaştırılması

Canan BALCI, Remziye Gül SIVACI, Özlem SAKA, Gökhan AKBULUT