Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Impact of General Anesthesia vs Local Anesthesia with Intravenous Sedation on the Incidence of Postoperative Cognitive Dysfunction after Cataract Surgery in Elderly Patients

Document Type : Original Article (s)

Authors
Khosrou Naghibi 1
Amir Shafa 2
Anahita Hirmanpour 2
Behnoush Sabaghi 3
1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Post-operative cognitive dysfunctions such as delirium are one of the most important complications after surgeries. There are many risk factors for post-operative cognitive dysfunction and the role of general versus regional anesthesia remains unclear.Methods: In this prospective randomized study, 360 old patients, referred to Feiz educational hospital In Isfahan, Iran were selected and randomly divided into general or regional anesthesia. A questionnaire was filled for each patient including name, age, gender, weight, type of anesthesia and educational status. Patients were evaluated with mini mental status examination (MMSE) questionnaire for the assessment of cognitive function in the day of admission, 24 hours and one week after cataract surgery. In the mentioned questionnaire the score below 20 indicates definite cognitive impairment.Findings: Post cataract surgery MMSE score was below 20 in 3.88% and 6.66% of patients in regional anesthesia and general anesthesia group, respectively. The result indicated that regional anesthesia decreases the MMSE scoring compared to general anesthesia (P < 0.001).Conclusion: Regional anesthesia method was better than general anesthesia for elder patients undergoing cataract surgery.
Keywords
Postoperative cognitive dysfunction
Delirium
Cataract surgery
Anesthesia methods
  1. Sadock BJ, Kaplan HI, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. 9th ed. Philadelphia PA: Lippincott Williams and Wilkins; 2009.
  2. Rudolph JL, Marcantoni ER. Caring for the postoperative patient with delirium. The Hospitalist 2004; 8: 20-5.
  3. van der Mast RC, Roest FH. Delirium after cardiac surgery: A critical review. J Psychosom Res 1996; 41(1): 13-30.
  4. Gokgoz L, Gunaydin S, Sinci V, Unlu M, Boratav C, Babacan A, et al. Psychiatric complications of cardiac surgery postoperative delirium syndrome. Scand Cardiovasc J 1997; 31(4): 217-22.
  5. Katon W, Sulvia M, Michael R. Cardiovascular disorder. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 6th ed. Philadelphia PA: Williams and Wilkins; 1995. p. 1491.
  6. Aakerlund LP, Rosenberg J. Postoperative delirium: Treatment with supplementary oxygen. Br J Anaesth 1994; 72(3): 286-90.
  7. Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 1995; 155(5): 461-5.
  8. van der Mast RC. Postoperative delirium. Dement Geriatr Cogn Disord 1999; 10(5): 401-5.
  9. Juliebo V, Bjoro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 2009; 57(8): 1354-61.
  10. Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg 1995; 80(6): 1223-32.
  11. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH. The association of intraoperative factors with the development of postoperative delirium. Am J Med 1998; 105(5): 380-4.
  12. Oh YS, Kim DW, Chun HJ, Yi HJ. Incidence and risk factors of acute postoperative delirium in geriatric neurosurgical patients. J Korean Neurosurg Soc 2008; 43(3): 143-8.
  13. Agnoletti V, Ansaloni L, Catena F, Chattat R, de Cataldis A, di Nino G, et al. Postoperative delirium after elective and emergency surgery: Analysis and checking of risk factors. A study protocol. BMC Surg 2005; 5: 12.
  14. Taban H, Ahmadzadeh GHH, Tavasoli MH. Pre and post operation cognitive disorder in older persons. Hormozgan Med J 2003; 7(3): 135-9. [In Persian].
  15. Milstein A, Pollack A, Kleinman G, Barak Y. Confusion/delirium following cataract surgery: an incidence study of 1-year duration. Int Psychogeriatr 2002; 14(3): 301-6.
  16. Dai YT, Lou MF, Yip PK, Huang GS. Risk factors and incidence of postoperative delirium in elderly Chinese patients. Gerontology 2000; 46(1): 28-35.
  17. Ni CA, Valacio R, Kelly J, O'Keefe S. Use of the abbreviated mental test to detect postoperative delirium in elderly people. Br J Anaesth 1995; 75(4): 481-2.
  18. Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry 2001; 23(2): 84-9.
  19. Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003; 47(10): 1204-10.
  20. Ishii K, Kabata T, Oshika T. The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients. Am J Ophthalmol 2008; 146(3): 404-9.
  21. Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth 1998; 81(3): 449-62.
  22. Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet 1955; 269(6884): 259-63.
  23. Blundell E. A psychological study of the effects of surgery on eighty-six elderly patients. Br J Soc Clin Psychol 1967; 6(4): 297-303.
  24. Wacker P, Nunes PV, Cabrita H, Forlenza OV. Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord 2006; 21(4): 221-7.
  25. Olin K, Eriksdotter-Jonhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg 2005; 92(12): 1559-64.
  26. Echigoya Y, Kato H. Causes of postoperative delirium after abdominal surgery in elderly patients. Masui 2007; 56(8): 932-6. [In Japanese].
  27. Tashakori A, Shanehsaz A, Khajeh Mougahi N. Comparison of incidence rate of post opera tive delirium between patients with open heart surgery and general surgery Ahwaz Golestan hospital 1999. Jundishapur Sci Med J 2004; (41): 37-43. [In Persian].
  28. Biedler A, Juckenhofel S, Larsen R, Radtke F, Stotz A, Warmann J, et al. Postoperative cognition disorders in elderly patients. The results of the "International Study of Postoperative Cognitive Dysfunction" ISPOCD 1. Anaesthesist 1999; 48(12): 884-95. [In German].
  29. Morimoto Y, Yoshimura M, Utada K, Setoyama K, Matsumoto M, Sakabe T. Prediction of postoperative delirium after abdominal surgery in the elderly. J Anesth 2009; 23(1): 51-6.
  30. Cryns AG, Gorey KM, Goldstein MZ. Effects of surgery on the mental status of older persons. A meta-analytic review. J Geriatr Psychiatry Neurol 1990; 3(4): 184-91.
  31. Asaee R, Nasari H, Hoseini S. Prevalence of delirium in hospitalized internal medicine and surgical adult patients in Shohadaye Ashayer Hospital of Khoramabad. Yafteh 2008; 10(3): 21-7. [In Persian].
  32. Anwer HM, Swelem SE, el-Sheshai A, Moustafa AA. Postoperative cognitive dysfunction in adult and elderly patients-general anesthesia vs subarachnoid or epidural analgesia. Middle East J Anaesthesiol 2006; 18(6): 1123-38.
  33. Gustafson Y, Brannstrom B, Berggren D, Ragnarsson JI, Sigaard J, Bucht G, et al. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 1991; 39(7): 655-62.
  34. Shi HJ, Xue XH, Wang YL, Zhang WS, Wang ZS, Yu AL. Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients. Int J Clin Exp Med 2015; 8(3): 3883-8.
  35. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: A systematic review with meta-analysis. J Alzheimers Dis 2010; 22(Suppl 3): 67-79.
Journal of Isfahan Medical School
Volume 34, Issue 372 - Serial Number 372
January and February 2016
Pages 134-142

  • Receive Date 25 November 2015
  • Accept Date 06 April 2022