Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy
DOI:
https://doi.org/10.15587/2519-4798.2021.224892Keywords:
inhalation anesthesia, total intravenous anesthesia, laparoscopic cholecystectomy, cortisol, insulin, glucose, cognitive dysfunction, elder patientsAbstract
The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients.
Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated.
Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001).
In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery.
According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001).
On the fifth postoperative day, no significant differences in baseline values between the Luria test and the MMSE scale were detected.
Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient.
According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period
References
- Iwasaki, M., Edmondson, M., Sakamoto, A., Ma, D. (2015). Anesthesia, surgical stress, and “long-term” outcomes. Acta Anaesthesiologica Taiwanica, 53 (3), 99–104. doi: http://doi.org/10.1016/j.aat.2015.07.002
- Zhang, C., Li, C., Xu, Z., Zhao, S., Li, P., Cao, J., Mi, W. (2016). The effect of surgical and psychological stress on learning and memory function in aged C57BL/6 mice. Neuroscience, 320, 210–220. doi: http://doi.org/10.1016/j.neuroscience.2016.02.015
- Kotekar, N., Shenkar, A., Nagaraj, R. (2018). Postoperative cognitive dysfunction – current preventive strategies. Clinical Interventions in Aging, 13, 2267–2273. doi: http://doi.org/10.2147/cia.s133896
- Lin, X., Chen, Y., Zhang, P., Chen, G., Zhou, Y., Yu, X. (2020). The potential mechanism of postoperative cognitive dysfunction in older people. Experimental Gerontology, 130, 110791. doi: http://doi.org/10.1016/j.exger.2019.110791
- Riedel, B., Browne, K., Silbert, B. (2014). Cerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction. Current opinion in anaesthesiology, 27 (1), 89–97. doi: http://doi.org/10.1097/aco.0000000000000032
- Rundshagen, I. (2014). Postoperative cognitive dysfunction. Deutsches Arzteblatt international, 111 (8), 119–125. doi: http://doi.org/10.3238/arztebl.2014.0119
- Segal-Gidan, F. (2017). Postoperative confusion in older adults. Journal of the American Academy of Physician Assistants, 30 (4), 12–16. doi: http://doi.org/10.1097/01.jaa.0000513345.29384.39
- Kirov, M. Iu., Kuzkov, V. V. (2012). Optimizatsiia gemodinamiki v perioperatsionnom periode: obzor literatury. Vestnik anesteziologii i reanimatologii, 9 (5), 56–66.
- Oliveira, C. R., Bernardo, W. M., Nunes, V. M. (2017). Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Brazilian journal of anesthesiology, 67 (1), 72–84. doi: http://doi.org/10.1016/j.bjane.2015.09.001
- Gibbison, B., Spiga, F., Walker, J. J., Russell, G. M., Stevenson, K., Kershaw, Y. et. al. (2015). Dynamic Pituitary-Adrenal Interactions in Response to Cardiac Surgery. Critical Care Medicine, 43 (4), 791–800. doi: http://doi.org/10.1097/ccm.0000000000000773
- Lupien, S. J., Maheu, F., Tu, M., Fiocco, A., Schramek, T. E. (2007). The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain and Cognition, 65 (3), 209–237. doi: http://doi.org/10.1016/j.bandc.2007.02.007
- Widmer, I. E., Puder, J. J., König, C., Pargger, H., Zerkowski, H. R., Girard, J., Müller, B. (2005). Cortisol Response in Relation to the Severity of Stress and Illness. The Journal of Clinical Endocrinology & Metabolism, 90 (8), 4579–4586. doi: http://doi.org/10.1210/jc.2005-0354
- Prado, C. E., Crowe, S. F. (2019). Corticosteroids and Cognition: A Meta-Analysis. Neuropsychology Review, 29 (3), 288–312. doi: http://doi.org/10.1007/s11065-019-09405-8
- Rasmussen, L. S., O’Brien, J. T., Silverstein, J. H., Johnson, T. W., Siersma, V. D. et. al. (2005). Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiologica Scandinavica, 49 (9), 1225–1231. doi: http://doi.org/10.1111/j.1399-6576.2005.00791.x
- Ji, M.-H., Shen, J.-C., Gao, R., Liu, X.-Y., Yuan, H.-M., Dong, L. et. al. (2013). Early postoperative cognitive dysfunction is associated with higher cortisol levels in aged patients following hip fracture surgery. Journal of Anesthesia, 27 (6), 942–944. doi: http://doi.org/10.1007/s00540-013-1633-5
- Piekarska, M., Buda, M., Deja, M. (2019). Assessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery. Polish Journal of Cardio-Thoracic Surgery, 16 (3), 118–123. doi: http://doi.org/10.5114/kitp.2019.88600
- Mu, D.-L., Li, L.-H., Wang, D.-X., Li, N., Shan, G.-J., Li, J. et. al. (2013). High Postoperative Serum Cortisol Level Is Associated with Increased Risk of Cognitive Dysfunction Early after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study. PLoS ONE, 8 (10), e77637. doi: http://doi.org/10.1371/journal.pone.0077637
- Glumac, S., Kardum, G., Karanović, N. (2018). A Prospective Cohort Evaluation of the Cortisol Response to Cardiac Surgery with Occurrence of Early Postoperative Cognitive Decline. Medical Science Monitor, 24, 977–986. doi: http://doi.org/10.12659/msm.908251
- Hashmi, N. K., Podgoreanu, M. V.; Akhtar, S., Rosenbaum, S. (Eds.) (2018). Stress Response to Surgery in the Elderly. Principles of Geriatric Critical Care. Cambridge University Press, 168–186.
- Tran, T. T., Kaneva, P., Mayo, N. E., Fried, G. M., Feldman, L. S. (2014). Short-stay surgery: What really happens after discharge? Surgery, 156 (1), 20–27. doi: http://doi.org/10.1016/j.surg.2014.03.024
- Maillard, J., Elia, N., Haller, C. S., Delhumeau, C., Walder, B. (2015). Preoperative and early postoperative quality of life after major surgery - a prospective observational study. Health and Quality of Life Outcomes, 13 (1), 12. doi: http://doi.org/10.1186/s12955-014-0194-0
- Shoar, S., Naderan, M., Ebrahimpour, H., Soroush, A., Nasiri, S., Movafegh, A., Khorgami, Z. (2016). A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum. International Journal of Surgery, 28, 28–33. doi: http://doi.org/10.1016/j.ijsu.2016.02.043
- Kothari, B., Rao, G. (2017). Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertary care hospital, Bhuj, Gujarat, India: a prospective study. International Surgery Journal, 4 (5), 1575–1578. doi: http://doi.org/10.18203/2349-2902.isj20171516
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Copyright (c) 2021 Елена Владимировна Белых, Марине Акоповна Георгиянц, Елена Владимировна Высоцкая, Анна Николаевна Страшненко
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