The effect of anesthesiological factors on postoperative cognitive dysfunction, delirium and mortality.

Dekker, M. (2015) The effect of anesthesiological factors on postoperative cognitive dysfunction, delirium and mortality. thesis, Medicine.

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Abstract

Introduction: Cancer is a disease of ageing, and since our population is ageing the incidence of cancer will increase. Cancer treatment often involves major surgery, and therefore the number of patients who require surgery as part of their cancer treatment will also increase. Postoperative cognitive dysfunction (POCD) is one of the many complications after major surgery. POCD could lead to a patients loss of independence and therefore could reduce a patients quality of life. The loss of independence could lead to high healthcare cost, and this could affect our whole society. Aim: The aim of this study was to gain knowledge about POCD, as identification of preventive measures may help to reduce the incidence of the problem. Primary endpoint: the incidence of POCD. Secondary endpoints: correlations between type of anesthetic agent, low BIS (as a measurement for deep anesthesia) and hypocapnia and outcome (defined as morbidity; POCD and delirium and mortality). Method: This study was a retrospective analysis of prospectively collected data from the PICNIC study. The data was collected with the use of Rugloop software. The available data was first sorted with IBM SPSS statistics 22.0.0. Additional data were digitalized manually with the case record forms. For the analysis of POCD Z-scores and combined Z-scores were used. POCD was defined as: a deterioration of 2 standard deviations (SD) in at least 2 tests, and/or, a deterioration of 2SD in combined Z-score. Low BIS was defined as BIS<45. BIS was also analyzed as a variable influenced by depth and duration. Hypocapnia was defined as end-tidal CO2 < 4,7kPa, and this was as well as low BIS analyzed as a variable influenced by depth and duration. Results: The data of 193 patients were analyzed. The incidence of POCD was 3,2%. There were no associations found between any of the studied variables and POCD. Patients who were treated using intravenous anesthesia received statistically significant more anesthesia compared to patients who received a volatile agent. There were associations found between low BIS and delirium (P = 0,001) as well as low BIS and mortality (P = 0,027). Also hypocapnia was statistically significant associated with delirium and mortality (P = 0,000 and P = 0,014). Conclusion: There were no associations found between any of the outcome variables and POCD. This is mostly due to the low incidence of postoperative cognitive dysfunction. Low BIS was associated with worse outcome (delirium and mortality). Hypocapnia was also significantly associated with worse outcome, and since hypocapnia is mostly caused by hyperventilation an evaluation of anesthesiologist ventilatory management is needed.

Item Type:	Thesis (Thesis)
Supervisor name:	Absalom, Prof. Dr. A.R.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:49
Last Modified:	25 Jun 2020 10:49
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1008

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