Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000500006
Brazilian Journal of Anesthesiology
Scientific Article

Disfunção cognitiva pós-operatória: prevalência e fatores associados

Postoperative cognitive dysfunction: prevalence and associated factors

Gustavo Luchi Boos; Luiz Fernando Soares; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942005000500006 Braz J Anesthesiol, vol.55, n5, p.517-524, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: A disfunção cognitiva pós-operatória (DCPO) está relacionada a fatores como o estado físico, distúrbios eletrolíticos, visuais e imunológicos, alcoolismo, fármacos e senilidade. Este estudo teve por objetivos determinar a prevalência de DCPO e seus fatores associados. MÉTODO: Foram estudados 55 pacientes, com idade entre 18 e 89 anos, submetidos a cirurgias eletivas ortopédicas, urológicas, digestivas ou vasculares, sob anestesia geral ou regional. Foi aplicado o Mini-Exame de Estado Mental (MEEM) na véspera da data da cirurgia (M0), 24 horas após (M1) e 3 a 7 dias após a cirurgia (M2). A DCPO foi caracterizada por escore do MEEM menor que 24/30 pontos ou diferença maior ou igual a 4 pontos em relação a M0. As variáveis utilizadas nas análises uni e multivariadas foram a idade, o sexo, o tipo de anestesia, o tipo de cirurgia, a ocorrência de hipotensão arterial, hipoxemia ou hipocapnia intra-operatórias, o uso de atropina e a duração da cirurgia. RESULTADOS: DCPO ocorreram em oito pacientes (14,54%). Todos os casos de DCPO ocorreram em pacientes com idade superior a 65 anos. Nesta faixa etária, a prevalência de DCPO foi de 28,57%. Somente a idade e os valores pré-anestésicos do MEEM diferiram entre os que apresentaram e os que não apresentaram DCPO. O modelo logístico incluiu somente o escore pré-anestésico do MEEM. CONCLUSÕES: Entre as variáveis incluídas neste estudo, somente o valor pré-anestésico do escore do MEEM pode ser considerado um fator de previsão independente da ocorrência de DCPO.

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Abstract

BACKGROUND AND OBJECTIVES: Postoperative cognitive dysfunction (POCD) is related to factors such as physical status, electrolytic, visual and immune disorders, alcoholism, drugs and advanced age. This study aimed at determining the prevalence of POCD and its associated factors. METHODS: Participated in this prospective study 55 patients aged 18 to 89 years, scheduled for elective orthopedic, urologic, general or vascular surgeries, under general or regional anesthesia. The Mini-Mental State Examination (MMSE) was applied the day before surgery (M0), at 24 postoperative hours (M1) and 3 to 7 days after surgery (M2). POCD was defined as MMSE score below 24/30 or as a difference equal to or above 4 as compared to M0. Univariate and multivariate analysis variables included age, gender, type of anesthesia and surgery, intraoperative hypotension, hypoxemia or hypocapnia, use of atropine and surgery length. RESULTS: POCD was observed in eight patients (14.54%). All POCD patients were above 65 years of age. Among these patients, the prevalence of POCD was 28.57%. Only age and preanesthetic MMSE scores were different between patients with or without POCD. The logistic model included only preanesthetic MMSE scores. CONCLUSIONS: Among the variables included in this study, only preanesthetic MMSE score is a significant independent predictor of POCD.

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Referências

Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesthesiol. 1998;15:761-764.

Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg. 1995;80:1223-1232.

Zakriya KJ, Christmas C, Wenz JF. Preoperative factors associated with postoperative change in confusion assessment method score in hip fracture patients. Anesth Analg. 2002;94:1628-1632.

Rasmussen LS, Johnson T, Kuipers HM. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003;47:260-266.

Duppils GS, Wikblad K. Acute confusional states in patients undergoing hip surgery. a prospective observation study. Gerontology. 2000;46:36-43.

Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17:259-272.

Canet J, Raeder J, Rasmussen LS. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand. 2003;47:1204-1210.

Gallinat J, Moller H, Moser RL. Postoperative delirium: risk factors, prophylaxis and treatment. Anaesthesist. 1999;48:507-518.

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.

Almeida OP. Mini exame do estado mental e o diagnóstico de demência no Brasil. Arq Neuropsiquiatr. 1998;56:605-612.

Cohendy R, Brougere A, Cuvillon P. Anaesthesia in the older patient. Curr Opin Clin Nutr Metab Care. 2005;8:17-21.

Moller JT, Cluitmans P, Rasmussen LS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857-861.

Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med. 1995;155:461-465.

Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth. 1998;81:449-462.

Thompson TL 2nd, Moran MG, Nies AS. Psychotropic drug use in the elderly. (Second of two parts). N Engl J Med. 1983;308:194-199.

Richardson JS, Miller PS, Lemay JS. Mental dysfunction and the blockade of muscarinic receptors in the brains of the normal elderly. Prog Neuropsychopharmacol Biol Psychiatry. 1985;9:651-654.

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