Yeliz KILIÇ, Mustafa Değer BİLGEÇ, Burak Taha SARIOĞLAN, Gülay ERDOĞAN KAYHAN, Mehmet Sacit GÜLEÇ, Ahmet ÖZER

Katarakt cerrahisi uygulanan geriatrik hastalarda topikal ve lokal anestezinin postoperatif bilişsel fonksiyonlar üzerine etkisi

Giriş: Postoperatif bilişsel işlev bozukluğu (POBİB), özellikle sınırlı bilişsel kapasiteye sahip yaşlılarda, anestezistler ve cerrahlar için önemli bir endişe haline gelmiştir. Genel anestezi, bu antite için iyi bilinen bir risk faktörüdür. Bununla birlikte, topikal/lokal anestezi ile POBİB arasındaki ilişki hakkında yeterli veri yoktur. Bu çalışma, katarakt ameliyatı geçiren yaşlı hastalarda topikal ve lokal anestezinin POBİB gelişimine etkisini araştırmayı amaçladı. Yöntemler: Bu çalışmaya katarakt ameliyatı geçiren 65 yaş üstü hastalar alındı. Tüm hastalar iki anestezi grubundan birine atandı; topikal (n=16) ve lokal (n=25). Bilişsel durum preoperatif ve postoperatif (1. saat, 1. gün ve 1. hafta) Blessed Orientation-Memory-Concentration (BOMC) testi ile değerlendirildi. Bulgular: İki anestezi grubu yaş, cinsiyet, American Society of Anesthesiologist skoru, eğitim durumu ve başlangıç hemodinamik değerleri açısından benzerdi (p>0.05). Lokal ve topikal gruplarda tüm anestezi sonrası BOMC skorları preoperatif BOMC skorlarına göre azalmıştı. Gruplar arasında tüm BOMC puanlarında da farklılık yoktu (p>0.05). Sonuç: Katarakt cerrahisi uygulanan geriatrik hastalarda hem topikal hem de lokal anestezinin POBİB gelişimi üzerinde anlamlı bir etkisi yoktu.

Anahtar Kelimeler:

geriatrik, katarakt cerrahisi, lokal anestezi, postoperatif bilişsel fonksiyon bozukluğu, topikal anestezi

Impact of topical and local anesthesia on postoperative cognitive functions in geriatrics undergoing cataract surgery

Introduction: Postoperative cognitive dysfunction (POCD) has become a major concern for anesthesiologists and surgeons, particularly in elderlies who already have limited cognitive status. General anesthesia is a well known risk factor of this entity. However, there is insufficient data regarding the association between topical/local anesthesia and POCD. This study aimed to investigate the impact of topical and local anesthesia on the development of POCD in elderly patients undergoing cataract surgery. Methods: The patients above 65 years who underwent cataract surgery were enrolled in this study. All patients were assigned to one of two anesthesia groups; topical (n=16) and local (n=25). Cognitive status was assessed preoperatively and postoperatively (1th hour, 1th day, and 1th week), using Blessed Orientation-Memory-Concentration (BOMC) test. Results: The two anesthesia groups were similar in age, gender, American Society of Anesthesiologist score, educational status, and baseline hemodynamic values (p>0.05). All postanesthetic BOMC scores in local and topical groups decreased compared to preoperative BOMC scores. There were also no differences in all BOMC scores between the groups (p>0.05). Conclusion: Both topical and local anesthesia had no significant effect on the development of POCD in geriatric patients undergoing cataract surgery.

Keywords:

cataract surgery, geriatrics, local anesthesia, postoperative cognitive dysfunction, topical anesthesia,

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1. Sauër AM, Kalkman C, van Dijk D. Postoperative cognitive decline. J Anesth. 2009;23:256‑9.
2. Alalawi R, Yasmeen N. Postoperative Cognitive Dysfunction in the Elderly: A Review Comparing the Effects of Desflurane and Sevflurane. J Perianesth Nurs. 2018;33:732-40.
3. Brown EN, Pardon PL. The aging brain and anaesthesia. Curr Opin Anaesthesiol. 2013;26:414-9.
4. Geng YJ, Wu QH, Zhang RQ. Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial. J Clin Anesth. 2017;38:165-71.
5. Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc. 2005;53:622-8.
6. Rortgen D, Kloos J, Fries M, et al. Comparison of early cognitive function and recovery after desflurane or sevoflurane anaesthesia in the elderly: a double-blinded randomized controlled trial. Br J Anaesth. 2010;104:167-74.
7. Tang N, Ou C, Liu Y, Zuo Y, Bai Y. Effect of inhalational anaesthetic on postoperative cognitive dysfunction following radical rectal resection in elderly patients with mild cognitive impairment. J Int Med Res 2014;42:1252-61.
8. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111:119-25.
9. Fathy W, Hussein M, Khalil H. Effect of local anesthesia (with lidocaine vs bupivacaine) on cognitive function in patients undergoing elective cataract surgery. Local Reg Anesth. 2019;12:1-6.
10. Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitiveoutcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev. 2018;8:CD012317.
11. Upadhyaya AK, Rajagopal M, Gale TM. The Six Item Cognitive Impairment Test (6-CIT) as a screening test for dementia: comparison with Mini-Mental State Examination (MMSE). Curr Aging Sci. 2010;3:138-42.
12. Kalem ŞA, Öktem Ö, Emre M. [Kısa Blessed Oryantasyon-Bellek-Konsantrasyon Test (BOMC) ve Standardize Mini Mental Test (SMMT) betimsel istatistik değerlerinin bir normal erişkin Türk örnekleminde saptanması]. In Turkish. Arch Neuropsychiatry 2002;39:95-102.
13. Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol 2015;15:154.
14. Fathy W, Hussein M, Khalil H. Comparative effect of local anesthesia with lidocaine 2% versus topical anesthesia on cognitive function in ophthalmic surgery. Anesth Pain Med 2019;9:e97172.
15. Davis N, Lee M, Lin AY, et al. Postoperative cognitive function following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol 2014;26:369-76.
16. Zakriya K, Sieber FE, Christmas C, Wenz JF, Franckowiak S. Brief postoperative delirium in hip fracture patients affects functional outcome at three months. Anesth Analg 2004;98:1798-802.
17. Newman MF, Grocott HP, Mathew JP. Neurologic Outcome Research Group and the Cardiothoracic Anaesthesia Research Endeavors (CARE) Investigators of the Duke Heart Center. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke 2001;32:2874-81.
18. Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS, Ispocd Group. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 2009;110:548-55.