Roedig, G. and Taeger, Kai (2002) Memory function in the early postoperative period after cardiac surgery - Impact of the anaesthetic procedure and comparison with memory function after vascular surgery. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 43 (7-8). pp. 431-455. ISSN 0170-5334
Full text not available from this repository.Abstract
The incidence of neuropsychological malfunctions occurring within the first 2 weeks after surgery is indicated with rates of maximally 80%. In a third of the patients, they persist for more than a month. These types of dysfunctions belong to the complications arising after cardiac surgery that can have a negative influence on the patient's quality of life. Memory impairment is the most frequently described postoperative malfunction. In most cases, management of extracorporeal circulation and surgical techniques have been assumed as potential causes, but no definite result could be obtained by respective investigations yet. The present article describes the influence of two different kinds of general anaesthesia on early postoperative brain function in 52 patients aged 50 to 75 years who underwent elective aortocoronary bypass surgery and in a comparative group of 26 patients who underwent peripheral vascular surgery without extracorporeal bypass. The cardiac surgery patients were divided into 2 randomised groups of the same size. Anaesthesia was maintained by fentanyl administration, either in combination with the inhalational anaesthetic isoflurane (group 1) or with midazolam (group 2). The vascular surgery patients received fentanyl and isoflurane (group 3) for anaesthesia. The evaluation performed 1 - 2 days before surgery did not reveal any significant differences between the groups in terms of attention, concentration, memory, and verbal memory. Neither did the patients' self-assessment of their cognitive abilities show any specific group-related differences. In order to make a differentiated judgement of memory processes, a memory experiment, which was developed in cooperation with the Faculty of Psychology 11 of the University of Regensburg, was applied to test explicit and implicit memory as well as the susceptibility to retroactive interference. As no significant effect of the kind of operation and/or the kind of anaesthesia could be determined by statistical analysis of this experiment, the initial preoperative condition was considered to be similar in all patients. In the neuropsychological examination on the fourth postoperative day, all patients were interviewed again about their current state of well-being and anxiety. Memory testing was performed in a manner analogous to that used in the preoperative memory experiment. One patient of group 2 and 2 patients of group 3 could not participate in the follow-up examination, so that the statistical evaluation is based upon the data obtained from 24 patients in each group. Compared with the preoperative state, the patients assessed their present state of health as unchanged. However, a minor decrease in anxiety was reported by the patients of group 1 and 2, whereas the patients of group 3 did not notice any alteration in their state of anxiety. In all patients, the postoperative ability to freely memorize single words from a categorized list of terms presented to them before surgery was found to be decreased. While there was no difference to be found between the patients of group I and 3, the patients of group 2 obtained significantly worse results in this explicit memory test than the patients of group 1. No significant differences could be determined between the three groups with regard to implicit memory abilities. In all patients, both explicit and implicit memory was influenced by the effects of retroactive interference. Comparison of the two groups of coronary surgery patients did not reveal any differences in the length of the operation and the length of the extracorporeal circulation either; however, it took a significantly longer time until the "midazolam"-patients could be extubated. The significantly worse results obtained in the explicit memory test by the "midazolam"-patients compared to the patients who received isoflurane show that the different drugs administered for anaesthesia maintenance also have a different influence on the cognitive abilities of coronary surgery patients in the early postoperative period. A possible impairment by midazolam and/or a cerebroprotective effect of isoflurane in operations involving extracorporeal circulation may therefore be discussed. Since the vascular surgery patients of group 3 were similarly affected by cognitive dysfunction after anaesthesia as the patients of group 1, it appears that postoperative impairment of cognitive function cannot be solely attributed to influencing factors specifically related to cardiac surgery, especially not only to the influence of extracorporeal circulation. All of the patients were asked once more for a self-assessment of their cognitive abilities 2 months after their operation. About 90% of the patients responded. No differences were found between the groups. According to their own assessment, however, the patients had not yet regained the preoperative level of their cognitive abilities.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CORONARY-ARTERY BYPASS; HYPOTHERMIC CARDIOPULMONARY BYPASS; NERVOUS-SYSTEM DYSFUNCTION; NEURON-SPECIFIC ENOLASE; CEREBRAL BLOOD-FLOW; GENERAL-ANESTHESIA; COGNITIVE DYSFUNCTION; REGIONAL-ANESTHESIA; RANDOMIZED TRIAL; MENTAL FUNCTION; cardiovascular surgical procedures; anaesthetics; memory; memory disorders; postoperative complications; isoflurane; midazolam; fentanyl |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 09 Jun 2021 07:23 |
| Last Modified: | 09 Jun 2021 07:23 |
| URI: | https://pred.uni-regensburg.de/id/eprint/40094 |
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