ANALYSIS OF CHANGES IN THE COGNITIVE STATUS OF OPHTHALMIC PATIENTS USING REGIONAL ANESTHESIA

Abstract

Cognitive dysfunction in the postoperative period in ophthalmic patients is an important and interesting topic. These patients have decreased cognitive function due to reduced vision loss. After therapeutic treatment, numerous painful manipulations, it is time for surgery under general anesthesia. Anesthesia is a factor that increases the risk of deepening and development of postoperative cognitive dysfunction (POCD). The implementation of a multimodal method of analgesia, using regional anesthesia as one of the components, provides an opportunity to minimize the negative impact of drugs intraoperatively. One of the factors in the development of modified PKD is the use of opioids and benzodiazepines, prolonged and excessively deep sedation, invasive methods of therapy and monitoring. The presence of regional anesthesia makes it possible to reduce the number of narcotic analgesics used. Therefore, in the postoperative period we observe less pronounced manifestations of cognitive deficit, earlier activation of patients. The aim of our work was to study the effect of various methods of anesthesia, including the addition of the classical scheme of anesthesia to block the pterygopalatine fossa, on the cognitive functions in ophthalmic patients after end-to-end keratoplasty. The study was conducted on the basis of KP "Dnepropetrovsk Regional Clinical Ophthalmological Hospital". There were 73 patients under observation who underwent surgery for end-to-end keratoplasty. Among the patients were 42 men (57.5%) and 31 women

(42.5%), aged 21 to 80 years, mean age - 52.1 ± 2.1 years. Assessment was performed using neuropsychological testing using the Frontal Dysfunction Scale (FAB), the Short Mental Status Assessment Scale (MMSE), and the Luria Test. Testing was performed in 5 stages: the day before (stage 1), 6 hours after(stage 2) surgery, 24 hours (stage 3) after surgery, 7 days (4 stage) after surgery, 21 days (5 stage) after surgery surgical intervention. Patients were divided into two groups. The first group (K) consisted of 45 patients who underwent anesthesia according to the scheme previously adopted in the hospital (method of multicomponent balanced anesthesia using fentanyl and sibazone in premedication). In the second group (B), which included 28 patients, the scheme described above anesthesia was supplemented by blockade of the pterygopalatine fossa. Intraoperative monitoring of patients in both groups included: non-invasive measurement of blood pressure (BP), heart rate (HR); pulse oximetry; determination of blood gases (oxygen, carbon dioxide and inhalation anesthetic on inhalation and exhalation). Analgesia and depth of sedation were monitored by ANI (Аnalgesia Nociception Index) and BIS (Bispectral index) monitoring, respectively. Analysis of patient testing on the FAB scale showed that the decrease in group K was more pronounced and longer than in group B. The average values in group B reached baseline less than a week after the intervention, with an increase in baseline. Restoration of cognitive function on the MMSE scale in patients of group K to the initial level was slow: on the 21st day after surgery, the restoration of cognitive function was observed in 53.3% of patients, and in 46.7% the indicators remained below baseline.In group B, the restoration of cognitive functions occurred a week after surgery - the average score was 24 compared to baseline, with further improvement in 60.7% of patients. Thus, it can be argued that the use of multimodal methods of anesthesia using blockade of the pterygopalatine fossa allows to achieve adequate anesthesia against the background of reducing the total number of analgesic drugs used. The use of regional anesthesia as a component of multimodal anesthesia makes it possible to reduce the severity and duration of cognitive dysfunction.