Dependence of the postoperative cognitive dysfunction occurrence on the anesthesia depth in patients after coronary shunting
Objective. To analyze the dependence of the postoperative cognitive dysfunction (POCD) occurrence on the anesthesia depth in patients after coronary shunting, performed for іschemic heart disease (ІHD) in conditions of the artificial blood circulation application.
Маterials and methods. The coronary vessels shunting was performed in 79 patients, suffering the IHD, who were divided into two Groups, depending on one criterion – the anesthesia depth during perfusion. Into Group I the patients were included, in whom during anesthesia a bispectral analysis index (BIS) have had persisted on the level lower than 40, while into Group II – on the level from 40 tо 55. Preoperatively, on the 7th day and in 3 mo in both Groups the neurocognitive tests were applied: a scale of psychological state estimation (Mini Mental state examination - ММSЕ), аs well as the tests in accordance to Grooved pegboard procedure and in accordance to the Trial Making Test Part A procedure.
Results. Application of the MMSE test have demonstrated, that the Group I patients on the 7th postoperative day have gained by 7.8% (14.2; 5.6), аnd in 3 mo – by 3.8% (7.3; 3.4) lesser points, comparing with the points they gained preoperatively. The Group II patients on the 7th postoperative day have gained by 4.3% (-8.3; 4.3) lesser points, while a total quantity of points they gained in 3 mo did not differ from the sum of points they gained preoperatively (-5.3; 0).
The visual attention testing (Trial making test Part A) application have shown, that the Group I patients on the 7th postoperative day have wasted by 13.8% (11; 16.5), аnd in 3 mo - by 3.3% (0; 5.7) more time for the testing task performance, comparing with preoperative values. In the Group II on the 7th postoperative day the patients have wasted by 3% (-2.4; 5.7) more time, аnd in 3 mo - by 2.6% (3.7; 2.9) lesser time for the test performance, than preoperatively.
The testing results in accordance to the Grooved pageboard procedure were following. The Group I patients on the 7th postoperative day have wasted by 8% (5.5; 10.9), аnd in 3 mo - by 4.8% (2.5; 9.4) more time for the testing performance, than preoperatively, while the Group II patients – 7. (5.2; 12.3) and 3.6% (2.4; 9.8), accordingly.
Conclusion. The clinical investigations results in patients after the coronary shunting doing have shown, that while performance of artificial blood circulation the BIS indices on the level of 40 – 55 are corresponding to optimal depth of anesthesia, what guarantees the lowering of the POCD occurrence rate in early postoperative period and in 3 mo postoperatively. The BIS indices values lesser than 40 constitute a risk factor for the POCD occurrence during the coronary arteries shunting procedure in conditions of artificial blood circulation.
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