A Comparative Study of the Effects of Two Different Levels of End-Tidal Carbon Dioxide Pressure on Cognitive Dysfunction in Elderly Patients, after Cataract Surgery under General Anesthesia

Document Type : Original Article (s)

Authors

1 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aimed to compare the effect of two different levels of end-tidal carbon dioxide on cognitive impairment in elderly patients undergoing surgery.Methods: In this clinical trial study, 240 patients over 65 years of age were randomly distributed into two groups. In the first group, the end-tidal carbon dioxide (ETCO2) pressure was maintained in the range of 35-40 mmHg, and in the second group in the range of 40 to 45 mmHg. Patients' cognitive scores before surgery, and 24 hours, one week, and six weeks later were compared between the two groups.Findings: In the first 24 hours, the incidence of cognitive impairment was 12.5 and 11.7 percent in first and second groups, respectively; while at the first week after surgery, this rate was 6.7 and 11.7 percent, and at the sixth week, 5.0 and 9.2 percent, respectively, based on the short test of mental status. In all cases, the difference between the two groups was not statistically significant.Conclusion: ETCO2 in the range of 35 to 45 mmHg has no effect on the cognitive impairment of elderly patients under cataract surgery with general anesthesia. Therefore, further studies on the effects of different extents of ETCO2 on cognitive impairments are necessary.

Keywords

References

  1. Naghibi K, Shetabi H, Nasrollahi K, Mansouri N. The effect of intravenous midazolam and dexmedetomidine on prevention of cognitive dysfunction after cataract surgery in the elderly patients under general anesthesia compared with the control group. J Isfahan Med Sch 2019; 36(504): 1395-400. [In Persian].
  2. Rahimi M, Montazeri K, Kamali L, Moradi M, Naghibi K. Comparing the effects of magnesium sulfate and nitroglycerin on the control of hypertension during and after cataract surgery under local anesthesia and intravenous sedation. J Isfahan Med Sch 2016; 33(361): 2076-83. [In Persian].
  3. Rahimi Varposhti M, Naghibi K, Moradi Farsani D, Jazayeri SM. Effect of short term use of head band on postoperative pain after cataract surgery. Urmia Med J 2018; 28(11): 688-97. [In Persian].
  4. Naghibi K, Kashefi P, Abtahi AM. The comparison of preemptive effects of propofol, remifentanil and ketamine on post-operative pain scores and analgesic requirements in elective lower abdominal surgery under general anesthesia: A randomized, double-blinded study. J Res Med Sci 2013; 18(7): 567-72.
  5. Ritchie K, Polge C, de Roquefeuil G, Djakovic M, Ledesert B. Impact of anesthesia on the cognitive functioning of the elderly. Int Psychogeriatr 1997; 9(3): 309-26.
  6. Naghibi K, Nazemroaya B, Sargaran A. A comparison of the effect of intravenous dexamethasone and lidocaine on prevention of postoperative cognitive disorders in cataract surgery in elderly patients. J Isfahan Med Sch 2018; 36(484): 666-72. [In Persian].
  7. Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc 2003; 51(1): 4-9.
  8. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW. The association between delirium and cognitive decline: A review of the empirical literature. Neuropsychol Rev 2004; 14(2): 87-98.
  9. 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.
  10. Foroughan M, Jafari Z, Shirin Bayan P, Ghaem Magham Faraahani Z, Rahgozar M. Validation of Mini-Mental State Examination (MMSE) In the elderly population of Tehran. Adv Cogn Sci 2008; 10(2): 29-37. [In Persian].
  11. 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.
  12. Modabernia M, Forghan Parast K, Khalkhali S, Najafi K. Delirium in CCU. J Guilan Univ Med Sci 2002; 11(41): 1-6. [In Persian].
  13. Bloch-Salisbury E, Lansing R, Shea SA. Acute changes in carbon dioxide levels alter the electroencephalogram without affecting cognitive function. Psychophysiology 2000; 37(4): 418-26.
  14. Derakhshanfar A, Ghaleiha A, Niayesh A, Alizade S, Goodarzi MT, Ghorbanpoor M. Assessment OF THE frequency of cognitive disorder in older patients before and after surgery in Hamadan educational hospitals. Iran J Surg 2011; 18(4): 1-10. [In Persian].
  15. Fothergill DM, Hedges D, Morrison JB. Effects of CO2 and N2 partial pressures on cognitive and psychomotor performance. Undersea Biomed Res 1991; 18(1): 1-19.
  16. Raemer DB, Calalang I. Accuracy of end-tidal carbon dioxide tension analyzers. J Clin Monit 1991; 7(2): 195-208.
  17. Naghibi K, Moradi-Farsani D, Hirmandpour A, Forutan A. Comparison of the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section. J Isfahan Med Sch 2017; 35(424): 345-50. [In Persian].
  18. Forget H, Lacroix A, Cohen H. Persistent cognitive impairment following surgical treatment of Cushing's syndrome. Psychoneuroendocrinology 2002; 27(3): 367-83.
  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. 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.
  21. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351(9106): 857-61.
  22. Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, et al. Measurement of post-operative cognitive dysfunction after cardiac surgery: A systematic review. Acta Anaesthesiol Scand 2010; 54(6): 663-77.
Journal of Isfahan Medical School
Volume 37, Issue 533 - Serial Number 533
May and June 2019
Pages 747-753

Files

History

  • Receive Date: 26 February 2019
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics