Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (3): 193-286 ➤ Оценка влияния вида анестезии на развитие послеоперационной когнитивной дисфункции у детей с врожденными пороками сердца при малоинвазивных хирургических вмешательствах

Estimation of the influence of the type of anesthesia on the development of postoperative cognitive dysfunction in children with congenital heart defects with low invasive surgery

Authors: Gorbunov G.E., Rybka M.M., Volodina M.S., Karakhan N.V., Dadabaev G.M.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-3-247-256

UDC: 616.12-007-053.1-089.5

Link: Clinical Physiology of Blood Circulaiton. 2022; 3 (19): 247-256

Quote as: Gorbunov G.E., Rybka M.M., Volodina M.S., Karakhan N.V., Dadabaev G.M. Estimation of the influence of the type of anesthesia on the development of postoperative cognitive dysfunction in children with congenital heart defects with low invasive surgery. Clinical Physiology of Circulation. 2022; 19 (3): 247–56 (in Russ.). DOI: 10.24022/1814-6910-2022-19-3-247-256

Keywords:  postoperative cognitive dysfunction MoCA test endovascular procedure sedation

Received / Accepted:  07.02.2022 / 20.04.2022

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Abstract

Objective. To conduct a comparative analysis of changes in cognitive functions, hemodynamic state and sedation level in patients with congenital heart defects (CHD) under endovascular surgical or diagnostic procedures.

Material and methods. A single-center prospective randomized trial involving 70 patients with CHD who underwent endovascular therapeutic and diagnostic procedures. The patients were divided into two groups of 35 people: a group of total intravenous anesthesia (TIVA) and a group of inhalation anesthesia (IA). A comparative analysis of hemodynamics, the time of induction and awakening of patients, the depth of sedation, which was controlled by the level of the bispectral index (BIS), was carried out. Assessment of cognitive function was carried out by Montreal Cognitive Assessment (MoCA) testing. Based on the results obtained, a comparative analysis of the initial cognitive functions and their status after operations and a comparative analysis in anesthesia groups were carried out.

Results. Patients of both groups were comparable in terms of baseline hemodynamic parameters. As the surgical or diagnostic intervention was performed, no intergroup difference in these indicators was detected (p > 0.05). The patients were sedated on the RASS scale from -4 to -3, the BIS monitor readings in the TIVA group were 58 ± 3.83, and in the IA group 57 ± 2.40, there was no intergroup difference (p > 0.05). In the IA group, patients scored 27 ±1.38 points before surgery du-ring MoCA testing, in the TIVA group 27 ± 1.62, p = 0.98. The day after the operation, 27 ± 1.43 and 27 ± 1.67 points, respectively, p = 0.96.

Сonclusion. The anesthetics used can cause cognitive impairment in the early postoperative period, which can be fixed by MoCA testing. Sevoflurane and propofol have minimal effect on hemodynamics at induction and at the main stage of the endovascular procedure, allow it to be carried out as smoothly as possible at the required level of sedation depth, which allows the surgeon to perform manipulations in stable conditions, the anesthesiologist to be confident in the reliability of anesthesia.

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****
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About Authors

  • Gleb E. Gorbunov, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology; ORCID
  • Mariya S. Volodina, Anesthesiologist-Intensivist; ORCID
  • Natal’ya V. Karakhan, Anesthesiologist-Intensivist; ORCID
  • Gulumzhan M. Dadabaev, Cand. Med. Sci., Endovascular Surgeon; ORCID

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