The correlation among the type of anesthesia, cognitive dysfunction, postoperative behavioural changes and S100B levels after adenotonsillectomy in children
| Autor: | Stojanović Stipić, Sanda |
|---|---|
| Přispěvatelé: | Roje, Željka, Kardum, Goran, Đogaš, Zoran, Župan, Gordana, Kozina, Slavica |
| Jazyk: | chorvatština |
| Rok vydání: | 2023 |
| Předmět: |
Dijete
Intravenska anestezija Inhalation Anesthesia BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Otorhinolaryngology BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Otorinolaringologija S100 Calcium Binding Protein beta Subunit Tonzilektomija Beta podjedinica S100 proteina koji veže kalcij Kirurgija. Ortopedija. Oftalmologija udc:617(043.3) Adenoidektomija Inhalacijska anestezija Adenoidectomy Kognitivni poremećaji Razdoblje oporavka od anestezije Anesthesia Recovery Period Intravenous Anesthesia Surgery. Orthopaedics. Ophthalmology Cognition Disorders Child Tonsillectomy |
| Popis: | Cilj istraživanja bio je utvrditi povezanost između vrste anestezije, kognitivne funkcije, negativnih poslijeoperacijskih promjena ponašanja i razine neurološkog biomarkera proteina S100B. Prospektivna studija provedena je u KBC Split u 64 djece (dob 6-13, ASA I-II) nakon elektivne adenotozilektomije. Djeca su bila randomizirana u dvije skupine: intravenska (n = 32) i inhalacijska (n = 32). U intravenskoj skupini indukcija u anesteziju je učinjena propofolom, fentanilom i vekuronijumom i održavana kontinuiranom infuzijom propofola. U inhalacijskoj skupini indukcija je učinjena fentanilom, sevofluranom i vekuronijumom, te održavana sevofluranom. Anesteziolog koji je anestezirao djecu i otorinolaringolog koji ih je operirao, bio je isti za svu djecu. Kognitivnu funkciju procijenili smo primjenom dvaju testova različite složenosti (PsychE test): jednostavno vrijeme reakcije i paralelno vrijeme reakcije. Svako dijete je prošlo testiranje prije operacije, 2 sata i 24 sata nakon operacije. Procjena negativnih poslijeoperacijskih promjena ponašanja je učinjena upitnikom Post Hospitalization Behavior Questionnaire (PHBQ - 27 pitanja u 6 podljestvica). Protein S100B smo odredili u serumu djece koristeći imunokemijsku metodu “ECLIA“. U kognitivnom funkcioniranju prije anestezije, te 2 h i 24 sata nakon anestezije nije bilo jednoznačnih i jednosmjernih razlika između inhalacijske i intravenske anestezije. Djeca su postizala lošije rezultate u jednostavnom vremenu reakcije nakon inhalacijske anestezije, a nakon intravenske anestezije, lošiji rezultati su bili u paralelnom vremenu reakcije. Broj negativnih poslijeoperacijskih promjena ponašanja, u svih 6 podljestvica PHBQ upitnika, bio je u svim točkama mjerenja statistički značajno manji u intravenskoj skupini u odnosu na inhalacijsku skupinu u ; separacijskoj anksioznosti, općoj anksioznosti, apatija/povlačenje, poremećaju hranjenja i agresiji prema autoritetu. Vrijednosti neurološkog biomarkera S100B značajno su bile povećane nakon opće anestezije u odnosu na prijeoperacijske vrijednosti, no nije bilo razlike između dvije vrste anestezije. Na temelju rezultata našeg istraživanja, prednost ima korištenje totalne intravenske tehnike u odnosu na inhalacijsku, za operacije adenotonzilektomije u djece. The aim of the investigation was to determine the relationship among types of anesthesia, cognitive assessment, negative postoperative behavior changes and the level of neurological biomarkers protein S100B. Prospective study was conducted at the University Hospital Split on 64 children (aged 6-13, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups: TIVA (n = 32) and sevoflurane (n = 32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In sevoflurane group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. In all patients, surgery was performed by the same surgeon and anaesthesia was administered by the same anaesthesiologist. Cognitive assessment was conducted with two psychomotor evaluation tests (PsychE): simple reaction time and dual task. Each subject was examined preoperatively, 2 h and 24h after surgery. Evaluation of negative postoperative behavioral changes were performed with the Post Hospitalization Behavior Questionnaire (PHBQ:- 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days 1, 3, 7 and 14, and 6 months after surgery. S100B assays were performed using the electrochemiluminiscence immunoassay “ECLIA”. There were no unambiguous one-way differences between TIVA and sevoflurane group in cognitive function before anaesthesia, 2 hours and 24 hours after anaesthesia. Children had poorer results in simple reaction time after inhalation anaesthesia, while after TIVA, worse results were in dual task. The number of NPOBCs in all six PHBQ subscales at all follow-up time points was statistically significantly smaller in the TIVA group than in group S. The greatest difference was noticed in the separation anxiety subscale, general anxiety, apathy/withdrawal, eating disturbances, aggression towards authority and sleep anxiety. The values of neurological biomarker S100B were significantly increased after general anesthesia with regard to preoperative values, but there were no differences regarding the 2 types of anaesthesia. Based on the results of our research, we preferthe use of total intravenous techniques over inhalation, for adenotonsillectomy in children. |
| Databáze: | OpenAIRE |
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