| Popis: |
Pharmacological agents used to induce, maintain and complement anaesthesia may either contribute to, or mitigate against, the risk of adverse cognitive outcomes following surgery. While significant further research is required to fully evaluate the effects of these drugs, the evidence which is available supports the use of either propofol and thiopentone as induction agents, total intravenous anaesthesia or desflurane for maintenance of anaesthesia, and rocuronium with sugammadex for reversal as first line if neuromuscular blockade and reversal are required in the presence of cholinesterase inhibitors used to treat dementia. Premedication should only be used where specifically indicated. Analgesia should be multimodal; regional techniques should be considered in selected patients and appropriate doses of opioid analgesia should be prescribed where necessary. Drugs to avoid include benzodiazepines, atropine, cyclizine and tramadol. There is, at present, no significant evidence to support the use of intraoperative dexmedetomidine to prevent postoperative delirium or cognitive dysfunction. Depth of anaesthesia monitoring should be employed where possible to appropriately titrate anaesthesia. |
