Determinación del nivel cognitivo en pacientes mayores de 60 años sometidos a anestesia general balanceada y total intravenosa en los hospitales José Carrasco Arteaga y Vicente Corral Moscoso, Cuenca 2019

Abstract

Introduction: Brain function is affected in the perioperative period, the symptoms manifest during the postoperative period, with depression of the level of consciousness, impaired attention, memory, reaction time, and amnesia, which can last several hours later. General anesthesia, anesthetic drugs, and age are associated factors. Older adults can develop from cognitive deficits and postoperative delirium, which often go unnoticed. Research in recent years seeks solutions to mitigate these pathologies; it is important to determine the associated and aggravating factors such as the type and duration of anesthesia, type of surgery, pathological history, alterations in perioperative homeostasis, among others. Objective: To determine the cognitive alterations that occur in the post-anesthetic of patients undergoing balanced or intravenous general anesthesia. Material and Methods: Analytical and cross-sectional observational study, in 258 patients over 60 years of age, scheduled for elective surgical procedures, from the José Carrasco Arteaga and Vicente Corral Moscoso Hospitals in the city of Cuenca, from January to December of 2019, who were operated with balanced general anesthesia or total intravenous, to whom the minimental test was applied to evaluate the cognitive state.. Descriptive results are shown using absolute and percentage frequency measures, measures of central tendency and dispersion. To determine the degree of association between risk factors and cognitive impairment, the prevalence ratio and confidence intervals were applied. The sample was calculated with a confidence level of 95%, taking into account the prevalence of 20% described in other studies, with a margin of error of 0.05. Results: 258 patients between 60 and 91 years old were studied, with a mean of 70.7, obtaining a prevalence of postoperative cognitive impairment (PDD) of 37.6%, associated with factors such as female sex, age over 80 years, patients classified according to the American Society Anesthesia Physical Status (ASA PS) III and patients who presented complications during surgery. Conclusions: The decrease in cognitive capacity was significantly more notable in: women, long-lived adults, those with an ASA III classification and in patients with complications during the intraoperative period; It is important to identify these factors and take prior measures such as multidisciplinary evaluations that help prevent their appearance or reduce its severity.