Effects of Combined and General Anesthesia on Cognitive Functions for Patients Undergoing Cardiac Surgery Under CPB
DOI:
https://doi.org/10.1532/hsf.3885Keywords:
delayed neurocognitive recovery, cardiac anaesthesia, cardiac surgery, bypassAbstract
Background: Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery.
Methods: The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bioethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient’s disagreement.
MMSE test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery.
According to the planned anesthesia, patients were assigned into two groups: 1 – combined general + epidural anesthesia and 2 – general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded.
Results: Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment
(P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).
References
Abdel-Aziz K, Larner AJ. 2015. Six-item cognitive impairment test (6CIT): pragmatic diagnostic accuracy study for dementia and MCI. Int Psychogeriatr. Jun;27(6):991-7.
Bedford PD. 1955. Adverse cerebral effects of anaesthesia on old people. Lancet. 259–263.
Blenkarn GD, Briggs G, Bell J, Sugioka K. 1972. Cognitive Function after Hypocapnic Hyperventilation. Anaesthesiology. 37(4):381-6.
Cardiovascular diseases statistics. Available from https://ec.europa.eu/eurostat/statistics-explained/index.php/Cardiovascular_diseases_statistics#Cardiovascular_healthcare
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 269: 2386–2391.
Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. 2007. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry. Aug; 78(8): 790–799.
Evered L, Scott D, Silbert B, Maruff. 2011. Postoperative Cognitive Dysfunction Is Independent of Type of Surgery and Anesthetic. Anesthesia & Analgesia. 112(5):1179-1185.
Gregory L, Anna W. 2006. Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction. General anesthesia. July; 53: 669 677.
Jaeger J. 2018. Digit Symbol Substitution Test: The Case for Sensitivity Over Specificity in Neuropsychological Testing. J Clin Psychopharmacol. Oct;38(5):513-519.
Mason SE, Noel-Storr A, Ritchie CW. 2010. 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. 22(3):67-79.
Monk T, Weldon C, Garvan C, Dede D, Van der Aa M, Heilman K, et al. 2008. Predictors of Cognitive Dysfunction after Major Noncardiac Surgery. Anesthesiology. 108:18-30.
Polunina AG, Golukhova EZ, Guekht AB, Lefterova NP, Bokeria LA. 2014. Cognitive Dysfunction after On-Pump Operations: Neuropsycho¬logical Characteristics and Optimal Core Battery of Tests. Stroke Res Treat. 1–18.
Rasmussen LS, Johnson T, Kuipers HM, Kristensen D, Siersma VD, Vila P, et al. 2003. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesth Scand. 47(3): 260–6.
Rundshagen I. 2014. Postoperative kognitive Dysfunktion. Dtsch. Arztebl. Int. 111 (8), 119–125.
Selnes OA, Goldsborough MA, Borowicz LM Jr, Enger C, Quaskey SA, McKhann GM. 1999. Determinants of cognitive change after coronary artery bypass surgery: a multifactorial problem. The Annals of Thoracic Surgery. 67(6):1669-1676.
Scolletta S, Taccone FS, Donadello K. 2015. Brain injury after cardiac surgery. Minerva Anestesiologica. 81:662-677.
Weber CF, Friedl H, Hueppe M, Hintereder G, Schmitz-Rixen T, Zwissler B, Meininger D. 2009. Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA Study Subgroup Analysis. World J Surg. Jul;33(7).
Wollman SB, Orkin LR. 1968. Postoperative human reaction time and hypocarbia during anaesthesia. Br J Anaesth. 40(12):920-6.
