F. YILMAZ, İ. GÜNÜŞEN, A. ÇERTUĞ, Ö. ÖNEN SERTÖZ

The effect of dexmedetomidine on cognitive function and anxiety in middle-ear surgery

Amaç: Kontrollü hipotansiyon, intraoperatif kanamayı azaltmak amacıyla cerrahi operasyonlar sırasında sıklıkla kullanılır. Ancak, kontrollü hipotansiyon kognitif fonksiyonlar üzerine zararlı olabilir. Bu prospektif çalışma, sadece remifentanil infüzyonu ile deksmedetomidin ve remifentanilin birlikte infüzyonlarının kognitif fonksiyonlar ve anksiyete üzerine etkilerini karşılaştırmak amacıyla yapıldı. Gereç ve Yöntem: Timpanoplasti uygulanacak 40 hasta, remifentanil (1μg kg-1 yükleme; 0.25-0.5 μg kg-1 dk-1 infüzyon) ya da deksmedetomidin ile remifentanil infüzyonlarının birlikte uygulandığı (1 μg kg-1 deksmedetomidin yükleme ve bunu takiben 0.5 μg kg-1 sa-1 deksmedetomidin ve 0.25-0.5 μg kg-1 dk-1 remifentanil infüzyonu) 2 gruptan birisine randomize edildi. Hastaların operasyon süresince hemodinamik değişimleri, opiyat gereksinimi, kanama, operasyon sonrası derlenme zamanı, kognitif fonksiyonlar ve anksiyete skorları kaydedildi. Bulgular: Hemodinamik değişimler açısından deksmedetomidine ile remifentanil infüzyonu uygulanan grup ile sadece remifentanil infüzyonu uygulanan grupların benzer etkiye sahip oldukları bulundu. Derlenme zamanı remifentanil grubunda belirgin olarak kısaydı. Yine bu grup hastalarda operasyon sonrası 30 ve 120.dk da Mini-mental test, 30 ve 60.dk da ise Trieger dot testi sonuçları daha iyi bulunurken Digit symbol substitution testi ve anksiyete skorları açısından her iki grupta benzer sonuçlar elde edildi. Deksmedetomidin uygulanan hastaların anksiyete skorları sadece bazal değerlere göre daha düşüktü. Sonuç: Orta kulak cerrahisinde, deksmedetomidin ile karşılaştırıldığında kısa derlenme zamanı ve kognitif fonksiyonların erken düzelmesi nedeniyle remifentanil daha avantajlı bulundu.

Orta kulak cerrahisinde uygulanan deksmedetomidinin kognitif fonksiyonlar ve anksiyete üzerine etkisi

Aim: Controlled hypotension has been used commonly during surgical procedures to reduce intraoperative hemorrhage. However, it can be detrimental to cognitive functions. This study is a prospective trial conducted to compare the effects of remifentanil alone and dexmedetomidine supplemented with remifentanil infusions on cognitive function and anxiety. Materials and Methods: Forty patients scheduled for tympanoplasty were allocated randomly into groups to receive either remifentanil (1μg kg-1 loading; maintenance, 0.25-0.5 μg kg-1 min-1) or dexmedetomidine combined with remifentanil infusion (1 μg kg-1 dexmedetomidine loading; maintenance, 0.5 μg kg-1 h-1 dexmedetomidine and 0.25-0.5 μg kg-1 min-1 remifentanil). Hemodynamic changes, opioid requirement, bleeding, recovery time, cognitive functions and anxiety scores were recorded. Results: Dexmedetomidine combined with remifentanil was found to have the same effect as remifentanil alone on hemodynamics. The remifentanil group was associated with significantly shorter recovery time. A mini-mental status test at 30 and 120 min and the Trieger dot test at 30 and 60 min in the remifentanil group were better than the other group whereas the Digit symbol substitution test and anxiety scores were similar in both postoperatively. The patients in the dexmedetomidine group had only lower anxiety scores postoperatively according to baseline values. Conclusion: Remifentanil was more advantageous in middle ear surgery as it was associated with a shorter recovery time and earlier recovery of cognitive functions compared with the dexmedetomidine group.

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1) Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anesthesiol 2008;25:369-74.
2) Durmus M, But AK, Dogan Z, et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anesthesiol 2007;24:447-53.
3) Degoute CS. Controlled hypotension: A guide to drug choice. Drugs 2007;67:1053-76.
4) Celebi N, Artukoglu F, Dal D, et al. Effect of hypotensive anesthesia on cognitive function. A comparison of esmolol and remifentanil during tympanoplasty. Saudi Med J 2007;28:1357-61.
5) Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth 1998;81:449-62.
6) Heinke W, Koelsch S. The effects of anesthetics on brain activity and cognitive function. Curr Opin Anaesthesiol 2005;18:625-31. 7. Johnson T, Monk T, Rasmussen LS, et al. Postoperative Cognitive Dysfunction in Middle-aged Patients. Anesthesiology 2002;96:1351-7.
8) Gupta A, Stierer T, Zuckerman R, et al. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg 2004;98:632-41.,
9) Kindler CH, Harms C, Amsler F, et al. The Visual Analog Scale allows effective measurement of preoperative anxiety and detection of patients anesthetic concerns. Anesth Analg 2000;90:706-12. 10. Farah GJ, de Moraes M, Filho LI, et al. Induced hypotension in orthognathic surgery: a comparative study of 2 pharmacological protocols. J Oral Maxillofac Surg 2008;66:2261-9.
11) Ngwenyama NE, Anderson J, Hoernschemeyer DG, Tobias JD. Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents. Paediatr Anaesth 2008;18:1190-5.
12) Bringman H, Giesecke K, Thörne A, Bringman S. Relaxing music as pre-medication before surgery: a randomised controlled trial. Acta Anaesthesiol Scand 2009;53:759-764.
13) Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol Anesthesia: A comparison with Desflurane and Sevoflurane Anesthesia. Anesth Analg 2000;90:168-74.
14) Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.
15) Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970;49: 924-34.
16) Saricaoglu F, Celiker V, Basgul E, et al. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol 2005;22:154-63.
17) Duschek S, Schandry R. Reduced brain perfusion and cognitive performance due to constitutional hypotension. Clin Auton Res 2007;17:69-76. 18. Newman MF, Kramer D, Croughwell ND, et al. Differential age effects of mean arterial pressure and rewarming on cognitive dysfunction after cardiac surgery. Anesth Analg 1995;81:236-42.
19) Eckenhoff JE, Compton JR, Larson A, Davies RM. Assessment of cerebral effects of deliberate hypotension by psychological measurements. Lancet 1964;2:711-4.
20) Jacobi KE, Bohm BE, Rickauer AJ, et al. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 2000;12:202-7.
21) Wilhelm W, Schlaich N, Harrer J, et al. Recovery and neurological examination after remifentanil-desflurane or fentanil-desflurane anaesthesia for carotid artery surgery. Br J Anaesth 2001;86:44-9.
22) Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002;95:461-6. 23. Moerman AT, Foubert LA, Herregods LL, et al. Propofol versus remifentanil for monitored anaesthesia care during colonoscopy. Eur J Anaesthesiol 2003;20:461-6.
24) Newman MG, Trieger N, Miller JC. Measuring recovery from anesthesia-a simple test. Anest Analg 1969;48:136-40.
25) Bürkle H, Dunbar S, Van-Aken H. Remifentanil: A novel, short-actin, mu-opioid. Anesth Analg 1996;83:646-51.
26) Millar K, Jelicic M, Bonke B, Asbury AJ. Assessment of preoperative anxiety: comparison of measures in patients awaiting surgery for breast cancer. Br J Anaesth 1995;74:180-3. 27. Paris A, Kaufmann M, Toner PH, et al. Effects of clonidine and midazolam premedication on bispectral index and recovery after elective surgery. Eur J Anaesthesiol 2009;26:603-10.
28) Rasmussen LS, Larsen K, Houx P, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scan 2001;45:275-89.