Cognitive status of young adult patient after abdominal surgery: pre vs postoperative assessment

Introduction: Postoperative Cognitive Dysfunction (POCD) is a decline of cognitive function that occurs during the first days or few weeks after the surgery. POCD was mainly studied in elderly patients after major surgery (cardiac and vascular surgery, joint replacement). The prevalence varies from 24% to 79%. There are only few studies concerning POCD in young adult patients. Also, there are no diagnostic criteria for POCD. Goals and objectives: Comparative assessment of pre- and postoperative cognitive performance in young adult patients after intermediate risk abdominal surgery. The ability to memorize the numbers, working with numerical series, coding number-symbol, color stroop effect was particularly appreciated. Materials and Methods: It is a prospective study, being approved by the Ethic Committee. Written informed consent, to participate in the study, was obtained from 17 young adult patients (>18 years). Patients were admitted to National Scientific and Practical Centre of Emergency Medicine to be subject to abdominal surgery. All patients were assessed pre- and postoperatively using 5 tests: 1. Mini Mental Status (MMS); 2. Digit Span Test (DST); 3. Digit Connection Test (DCT); 4. Digit Symbol Substitution Test (DSST); 5. Reedley Color Stroop Test (RCST). Results: The following results were obtained. MMS: 28,0 (95CI 26,72-29,28) vs. 28,19 (95CI 26,95-29,42), p=0,92. DST: 8,75 (95CI 8,15-9,35) vs. 9,13 (95CI 8,23-10,0), p=0,27. DCT: 35,03 (95CI 28,26-41,80) vs. 30,12 (95CI 24,80-35,43), p=0,0564. DSST: 37,50 (95CI 32,04-42,96) vs. 39,38 (95CI 33,52-45,23), p=0,18. RCST: 19,77 (95CI 17,77-21,76) vs. 19,43 (95CI 16,19-22,67), p=0,77. Conclusion: Cognitive status of young adult patients after abdominal surgery is not affected by anesthesia or surgery on the 4th - 7th day. Some particular aspects of cognitive function (working with numerical series, symbol decoding) seem to be affected by anesthesia or surgery (borderline statistical significance)

COGNITIVE STATUS OF YOUNG ADULT PATIENT AFTER ABDOMINAL SURGERY: PRE vs POSTOPERATIVE ASSESSMENT

Introduction: Postoperative Cognitive Dysfunction (POCD) is a decline of cognitive function that occurs during the first days or few weeks after the surgery. POCD was mainly studied in elderly patients after major surgery (cardiac and vascular surgery, joint replacement). The prevalence varies from 24% to 79%. There are only few studies concerning POCD in young adult patients. Also, there are no diagnostic criteria for POCD. Goals and objectives: Comparative assessment of pre- and postoperative cognitive performance in young adult patients after intermediate risk abdominal surgery. The ability to memorize the numbers, working with numerical series, coding number-symbol, color stroop effect was particularly appreciated. Materials and Methods: It is a prospective study, being approved by the Ethic Committee. Written informed consent, to participate in the study, was obtained from 17 young adult patients (>18 years). Patients were admitted to National Scientific and Practical Centre of Emergency Medicine to be subject to abdominal surgery. All patients were assessed pre- and postoperatively using 5 tests: 1. Mini Mental Status (MMS); 2. Digit Span Test (DST); 3. Digit Connection Test (DCT); 4. Digit Symbol Substitution Test (DSST); 5. Reedley Color Stroop Test (RCST). Results: The following results were obtained. MMS: 28,0 (95CI 26,72-29,28) vs. 28,19 (95CI 26,95-29,42), p=0,92. DST: 8,75 (95CI 8,15-9,35) vs. 9,13 (95CI 8,23-10,0), p=0,27. DCT: 35,03 (95CI 28,26-41,80) vs. 30,12 (95CI 24,80-35,43), p=0,0564. DSST: 37,50 (95CI 32,04-42,96) vs. 39,38 (95CI 33,52-45,23), p=0,18. RCST: 19,77 (95CI 17,77-21,76) vs. 19,43 (95CI 16,19-22,67), p=0,77. Conclusion: Cognitive status of young adult patients after abdominal surgery is not affected by anesthesia or surgery on the 4th - 7th day. Some particular aspects of cognitive function (working with numerical series, symbol decoding) seem to be affected by anesthesia or surgery (borderline statistical significance)

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

IMSP Institutul de Medicină Urgentă Centrul Naţional Ştiinţifico-Practic de Medicină Urgentă, Chişinău, MoldovaRezumat În pofida progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50, p<0,0011). De asemenea, a fost identifi cat un grad mediu de corelare dintre consumul intra-anestezic total de fentanil şi intensitatea durerii postoperatorii (r=0,34; p<0,013). Despite advances in postoperative pain management field, the prevalence of patients with severe postoperative pain is still high, 24-46%. For a better result, the postoperative pain management should take into consideration some specific risk factors for severe postoperative pain. Early identification of the factors in patients at risk of postoperative pain will allow a more effective intervention and a better management. For this aim, in our study were included 92, in which were evaluated the risk factor capacity of the following entities: pain catastrofizing, depression, preoperative pain, duration of the surgical operation, anxiety, redux, intra-anesthetic fentanil consumption. In our study, anxiety and high intra-anesthetic fentanyl doses were the most common predictors for severe postoperative pain. Also, was found a moderate degree of correlation between the total intra-anesthetic fentanil consumption and postoperative pain intensity. Несмотря на прогресс в лечении послеоперационной боли, распространенность сильной острой послеоперационной боли (СЩПБ) у пациентов остается высокой, 24-46%. Для улучшения качества послеоперационного обезболивания, нужно принять во внимание специфические факторы риска. С этой целью, мы про- вели исследование на 92 пациентах, дабы оценить являются ли факторами риска следующие: катастрофизм боли, депрессия, предоперационная боль, продолжительность операции, тревожности, операций проводимые на существующих уже послеоперационных шрамах, интра-операционное потребление фентанила. В результате исследования мы смогли доказать что тревожности является фактором риска (OR = 5,1, CI95 = 1,44 до 18,50, р <0,0011). Также была определена средняя степень корреляции между потреблением фентанила во время анестезий и послеоперационной интенсивностью боли (р = 0,34, р <0,013)

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

În pofi da progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50,

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

IMSP Institutul de Medicină Urgentă Centrul Naţional Ştiinţifico-Practic de Medicină Urgentă, Chişinău, MoldovaRezumat În pofida progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50, p<0,0011). De asemenea, a fost identifi cat un grad mediu de corelare dintre consumul intra-anestezic total de fentanil şi intensitatea durerii postoperatorii (r=0,34; p<0,013). Despite advances in postoperative pain management field, the prevalence of patients with severe postoperative pain is still high, 24-46%. For a better result, the postoperative pain management should take into consideration some specific risk factors for severe postoperative pain. Early identification of the factors in patients at risk of postoperative pain will allow a more effective intervention and a better management. For this aim, in our study were included 92, in which were evaluated the risk factor capacity of the following entities: pain catastrofizing, depression, preoperative pain, duration of the surgical operation, anxiety, redux, intra-anesthetic fentanil consumption. In our study, anxiety and high intra-anesthetic fentanyl doses were the most common predictors for severe postoperative pain. Also, was found a moderate degree of correlation between the total intra-anesthetic fentanil consumption and postoperative pain intensity. Несмотря на прогресс в лечении послеоперационной боли, распространенность сильной острой послеоперационной боли (СЩПБ) у пациентов остается высокой, 24-46%. Для улучшения качества послеоперационного обезболивания, нужно принять во внимание специфические факторы риска. С этой целью, мы про- вели исследование на 92 пациентах, дабы оценить являются ли факторами риска следующие: катастрофизм боли, депрессия, предоперационная боль, продолжительность операции, тревожности, операций проводимые на существующих уже послеоперационных шрамах, интра-операционное потребление фентанила. В результате исследования мы смогли доказать что тревожности является фактором риска (OR = 5,1, CI95 = 1,44 до 18,50, р <0,0011). Также была определена средняя степень корреляции между потреблением фентанила во время анестезий и послеоперационной интенсивностью боли (р = 0,34, р <0,013)