ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 23 of 61
JMBS 2019, 4(5): 154–159
Clinical Medicine

The Dependence between Severity of Post-Narcotic Cognitive Dysfunction and the Degree of Personal Dysaptation of Patients in Outpatient Anesthetic Practice

Naumenko V. О., Boyko O. V., Baranova N. V., Lantukhova N. D.

There has recently been a significant increase in the number of publications dealing with the issues of post-anesthesia cognitive dysfunction and examining the relationship between the degree of cognitive impairment with a certain type of general anesthesia, with a specific anesthetic, and with the type of the initial pathology in the patient. The results of these studies are of particular interest and importance for outpatient anesthesiological practice, where the rate of recovery of preoperative cognitive abilities of the patient is of significant economic importance, affects the organization of the treatment process, provision of drugs and safety of treatment in general. The purpose of the study was the identification of correlation between personal anxiety, emotional stress, neuroticism and the severity of cognitive dysfunction in anesthetic management of instrumental curettage of the uterine cavity in an outpatient setting. Material and methods. The state of such mobile personality traits as anxiety, neuroticism and depression was studied in all patients at the initial level. The following psychological tests were used: the definition of neuroticism according to Eysenck, the Taylor Manifest Anxiety Scale, the Scale of Extra- and Introversion according to Eysenck, Schulte Table and Scale of the MMPI. Anesthetic management was carried out in the form of total intravenous anesthesia based on propofol at a dose of 1.5 mg/kg, provided pre-administered premedication containing m-cholinolytic and analgesic fentanyl at a dose of 0.1 mg. The choice of anesthetic and premedication was not individualized. To assess the degree of cognitive impairment, we used the calculation of the index of cognitive impairment proposed by Mikhnevich K. G. calculated on the basis of the Schulte Test, the Clock Drawing Test, the Five-word Test, and the Dobkin-Gologorsky Scale. Further evaluation of the cognitive index was carried out in two stages: immediately after coming out of anesthesia, when the establishment of verbal contact and restoration of personal and spatial orientation began; 3 hours after the end of anesthesia. Results and discussion. According to the level of personal anxiety patients were divided into 3 groups: with high 28.24±0.01, medium 14.62±1.21 and low 10.42±0.9 levels of anxiety (p<0.01). The cognitive index in the groups did not differ significantly and amounted to -0.98±0.19. In further stages of the study, the values of cognitive index were (stage 1/stage 2): in group 1: - 3.46 ± 1.94/- 1.1 ± 0.11; in group 2: - 1.76 ± 0.62/- 0.96 ± 0.21; in group 3: - 0.72 ± 0.21/- 0.74 ± 0.12. Significant differences between groups at these stages were within p<0.01. Conclusions. The level of preoperative anxiety significantly influences the degree of severity and the pace of normalization of post-anesthesia cognitive dysfunction. Cognitive index should be used to assess cognitive dysfunction. Full recovery pre-anesthesia level of cognitive functions does not occur even if patients have low initial levels of anxiety.

Keywords: ambulatory anesthesiology, pre-anesthesia psycho-emotional stress, personal response, postoperative cognitive dysfunction, cognitive index

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