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Incidencia del dĆ©ficit cognitivo postoperatorio en anestesia regional y general en una instituciĆ³n de cuarto nivel en Bucaramanga (Santander, Colombia) en el aƱo 2017
Introduction. Within the aging process, most organic systems maintain their basal functions. However, there is a reduction in functional reserve and the capacity to compensate physiological stress, which makes older patients more prone to postoperative complications. A study was performed in institutions in Bucaramanga to determine the incidence of postoperative cognitive dysfunction and the associated risk factors. Methodology. This was a analytical observational prospective cohort study performed in healthcare institutions in Bucaramanga in 2017 with patients older than 55 years of age under regional, balanced general or total intravenous anesthesia. Results. One hundred and seventy-three operated patients were studied, among which 112 (64.74%) were women and 61 (35.26%) were men. The most commonly used anesthetic techniques were: regional (46.24%) and balanced general (44.51%). Short-term Postoperative Cognitive Dysfunction incidence was 6.36% in previously healthy patients, with an adjusted significant P value (0.001). Cognitive deterioration was detected in 51.41% of patients, with alterations in their mastery of language, attention and memory. This increased for the long-term evaluation. During long-term patient follow-up, it resulted in 11.55%, determining the incidence of delayed Postoperative Cognitive Dysfunction at 17.91%. The anesthetic technique with the highest proportion of long- term dysfunction was mixed anesthesia, compared to regional anesthesia. Discussion. There is currently no standardized definition for Postoperative Cognitive Dysfunction. It has been observed more frequently and for longer extensions in older patients. The study demonstrated a significantly lower early incidence when compared to international articles, but a greater incidence of delayed postoperative dysfunction as a result of more intraoperative complications compared to other studies. Conclusions. Postoperative Cognitive Dysfunction involves multiple risk factors. The study observed a greater association with age, level of education, hypotension and general anesthesia. There was no association between comorbidities and Postoperative Cognitive Dysfunction. The presence of hypotension was determined for developing this dysfunction.IntroduccioĢn. En el proceso de envejecimiento, la mayoriĢa de los sistemas orgaĢnicos mantienen su funcionamiento basal, pero existe una reduccioĢn de la reserva funcional y de la capacidad para compensar el estreĢs fisioloĢgico, lo que hace que los pacientes de mayor edad sean maĢs propensos a complicaciones postoperatorias. Se realizoĢ un estudio en instituciones de Bucaramanga para determinar la incidencia de deĢficit cognitivo postoperatorio y los factoresde riesgo asociados. MetodologiĢa. Estudio observacional analiĢtico de cohorte prospectivo realizado en instituciones de salud de Bucaramanga durante 2017 con pacientes mayores de 55 anĢos intervenidos bajo anestesia regional, general balanceada o anestesia total intravenosa. Resultados. Se estudiaron 173 pacientes, 112 mujeres (64.74%) y 61 hombres (35.26%) operados. Las teĢcnicas anesteĢsicas maĢs empleadas fueron: Regional (46.24%) y General balanceada (44.51%). La incidencia de DeĢficit Cognitivo Postoperatorio a corto plazo fue 6.36% en pacientes previamente sanos, con valor P significativo (0.001) ajustado. Se detectoĢ deterioro cognitivo del 51.41% con alteraciones en los dominios de lenguaje, atencioĢn y memoria; con aumento en la evaluacioĢn a largo plazo. Durante el seguimiento de pacientes a largo plazo resultoĢ en un 11.55%, determinando la incidencia de DeĢficit Cognitivo Postoperatorio tardiĢo en un 17.91%. La teĢcnica anesteĢsica con mayor proporcioĢn de deĢficit a largo plazo fue la anestesia mixta, comparada con anestesia regional. DiscusioĢn. En la actualidad no existe una definicioĢn estandarizada de DeĢficit Cognitivo Postoperatorio, se ha observado mayor frecuencia y mayor prolongacioĢn en pacientes de edad avanzada. El estudio demostroĢ una incidencia temprana significativamente menor, comparaĢndolo con artiĢculos internacionales, pero una incidencia mayor en deĢficit postoperatorio tardiĢo, resultado de mayores complicaciones intraoperatorias, comparado con otros estudios. Conclusiones. El DeĢficit Cognitivo Postoperatorio involucra muĢltiples factores de riesgo; en el estudio se encontroĢ mayor asociacioĢn con la edad, la escolaridad, la hipotensioĢn y la anestesia general. No hubo asociacioĢn entre comorbilidades y el DeĢficit Cognitivo Postoperatorio. Se determinoĢ la presencia de hipotensioĢn para desarrollo de este deĢficit