Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000500011
Brazilian Journal of Anesthesiology
Clinical Information

Efeito da anestesia geral na cognição e na memória do idoso

Effects of general anesthesia in elderly patients’ memory and cognition

Régis Borges Aquino; Antonio Carlos Araújo de Souza; Irani de Lima Argimon; Patrícia F. Ritter dos Santos

http://dx.doi.org/10.1590/S0034-70942004000500011 Braz J Anesthesiol, vol.54, n5, p.687-692, 2004
PDF Português
PDF English
Downloads: 0
Views: 975

Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia geral e a função mental têm sido alvo de estudos e considerações, especialmente pelo sentimento de que ela, particularmente em idosos, poderia induzir alterações na cognição e na memória. O objetivo dessa pesquisa foi avaliar o efeito da anestesia geral na cognição e na memória do idoso correlacionando-a ao sexo, à idade e ao tempo de anestesia. MÉTODO: Estudo de coorte controlado realizado em pacientes categorizados em dois grupos de observação: a- anestésico; b- clínicos (controle). As variáveis de desfecho consideradas foram os escores dos testes MiniMental, de Fluência Verbal e de Lembrança Numérica. Anestesia geral com halotano, isoflurano, sevoflurano, tiopental, propofol, etomidato, fentanil alfentanil, succinilcolina atracúrio, pancurônio. Intra-operatório com PaCO2 entre 30 e 45 mmHg e saturação de hemoglobina acima de 90% e tolerância de PA com diminuição até 20% do valor basal. Foram excluídos os pacientes que apresentaram algum evento adverso no intra e pós-operatório. Dados categóricos analisados pelo teste do Qui-quadrado. A comparação inicial entre os grupos no momento basal (pré-anestésico) foi realizada pelo t de Student para amostras independentes. Para avaliação do efeito do processo anestésico ao longo do tempo, foi utilizada a Análise de Variância (ANOVA) para medidas repetidas. RESULTADOS: No teste do MiniMental os grupos apresentaram comportamento semelhante sendo notado aumento de escores ao longo do tempo. No teste de Fluência Verbal, em ambos os grupos os escores mantiveram-se praticamente inalterados. No teste de Lembrança Numérica o comportamento dos grupos foi muito semelhante ao longo do seguimento sendo que os escores aumentaram em ambos os grupos. CONCLUSÕES: Não foi detectado declínio de cognição ou de memória no pós-operatório de idosos de 60 a 80 anos de ambos os sexos, submetidos à anestesia geral com duração de 3 a 7 horas.

Palavras-chave

ANESTESIA, ANESTESIA, SISTEMA NERVOSO CENTRAL, SISTEMA NERVOSO CENTRAL

Abstract

BACKGROUND AND OBJECTIVES: General anesthesia and mental function have been subject to studies and considerations, especially for the feeling that, especially in the elderly, it could induce changes in cognition and memory. This study aimed at evaluating the effects of general anesthesia in cognition and memory of elderly patients, correlating them to gender, age and anesthesia duration. METHODS: This is a cohort, controlled study with patients divided in two observation groups: a - anesthetic; b - clinical (control). Outcome variables studied were Mini-mental test, Verbal Fluency test and Numeric Remembrance test scores; general anesthesia with halothane, isoflurane, sevoflurane, thiopental, propofol, etomidate, fentanyl, alfentanil, succinylcholine, atracurium and pancuronium; intraoperative period with PaCO2 30 to 45 mmHg, hemoglobin saturation above 90% and blood pressure tolerance with up to 20% decrease as compared to baseline. Patients presenting any intra and postoperative adverse event were excluded from the study. Chi-square test was used for categorical data. Student’s t test for independent samples was used for initial comparison between groups at baseline moment (preanesthetic). Analysis of variance (ANOVA) for repeated measures was used to evaluate anesthetic process effects along time. RESULTS: Groups were similar in the Mini-Mental test with increased scores along time. Both groups had virtually unchanged Verbal Fluency test scores. Both groups were very similar in Numeric Remembrance test with increased scores in both groups. CONCLUSIONS: No postoperative cognition or memory decline has been observed in patients of both genders, aged 60 to 80 years, submitted to general anesthesia lasting 3 to 7 hours.

Keywords

ANESTHESIA, ANESTHESIA, CENTRAL NERVOUS SYSTEM, CENTRAL NERVOUS SYSTEM

References

Evers AS. Cellular and Molecular Mechanisms of Anesthesia. Clinical Anesthesia. 1989:119-136.

Oskvig RM. Special problems in elderly. Chest. 1999;115(^s5):158S-164S.

Blazer D. Epidemiologia dos Transtornos Psiquiátricos no Idoso. Psiquiatria Geriátrica. 1999:167-183.

Folstein M, Anthony JC, Parhad I. The meaning of cognitive impairment in the elderly. J Am Geriatr Soc. 1985;33:228-235.

Callicott JH, Mattay VS, Bertolino A. Physiological characteristics of capacity constraints in working memory as revealed by functional MRI. Cereb Cortex. 1999;9:20-26.

Larry RS. Mechanisms of memory. Science. 1986;232:1612-1619.

Guyton AC, Hall JE. O Córtex Cerebral; Funções Intelectuais do Cérebro; Aprendizagem e Memória. Tratado de Fisiologia Médica. 1997:661-673.

Lubke GH, Kerssens C, Gershon RY. Memory formation during general anesthesia for emergency cesarean sections. Anesthesiology. 2000;92:1029-1034.

Cork RC, Kihlstrom JF, Schacter DL. Absence of explicit or implicit memory in patients anesthetized with sufentanil/nitrous oxide. Anesthesiology. 1992;76:892-898.

Echevaria M, Caba F, Rodriguez J. Memória explícita e implícita durante anestesia inhalatória e intravenosa. Rev Esp Anestesiol Reanim. 1998;45:220-225.

Renna M, Lang EM, Lockwood GG. The effect of sevoflurane on implicit memory: a double- blind, randomised study. Anaesthesia. 2000;55:634-640.

Ghoneim MM, Block RI. Learning and memory during general anesthesia an update. Anesthesiology. 1997;87:387-410.

Veselis RA. Memory function during anesthesia. Anesthesiology. 1999;90:648-650.

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198.

Seidenberg M, O´Leary DS, Berent S. Changes in seizure frequency and test-retest scores on the Wechler Adult Intelligence Scale. Epilepsia. 1981;22:75-83.

Brucki SM, Malheiros SMF, Okamotto IH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr. 1997;55:56-61.

Firestone LL. General Preanesthetic Evaluation. Clinical Anesthesia Procedures of the Massachusetts General Hospital. 1988:3-14.

Ritchie K, Polge C, de Roquefeuil G. Impact of anesthesia on the cognitive functioning of the elderly. Int Psychogeriatr. 1997;9:309-326.

Brewer KK, Haq A, Cullum CM. Anesthesia exposure as a possible risk factor for cognitive decline in the elderly. Facts Res Gerontol. 1996;7:161-170.

Bedford PD. Adverse cerebral effects of anesthesia on old people. Lancet. 1955;6:259-263.

Storms LH, Stark AH, Calverley RK. Psychological functions after halothane or enflurane anesthesia. Anesth Analg. 1980;59:245-249.

Crul BJ, Hulstijn W, Burger IC. Influence of the type of anaesthesia on post-operative subjective physical well-being and mental function in elderly patients. Acta Anaesthesiol Scand. 1992;36:615-620.

Rollason WN, Robertson GS, Cordiner CM. A comparison of mental function in relation to hypotensive and normotensive anaesthesia in the elderly. Br J Anaesth. 1971;43:561-566.

Rosenberg J, Kehlet H. Postoperative mental confusion-association with postoperative hypoxemia. Surgery. 1993;114:76-81.

Hole A, Terjesen T, Breivik H. Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand. 1980;24:279-287.

Davison LA, Steinhelber JC, Eger EI. Psychological effects of halothane and isoflurane anesthesia. Anesthesiology. 1975;43:313-324.

Faintuch J, Machado CCM. Alterações Clínicas e Metabólicas no Período Pós-Operatório. Clínica Cirúrgica Alípio Correa Neto. 1988:24-31.

5dd6e5380e8825054113f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections