PERIOPERATIVE COGNITIVE DYSFUNCTION IN PATIENTS UNDERGOING ENT SURGERIES: ROLE OF DEPTH OF ANAESTHESIA MONITORING (BIS) AND DEXMEDETOMIDINE INFUSION
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Keywords
POCD, ENT surgeries, Anesthesia, Dexmedetomidine and BIS.
Abstract
Perioperative cognitive dysfunction (POCD) is a common complication following surgery, particularly in elderly patients, resulting in memory impairment, attention deficits, and decreased executive function. Factors such as anaesthetic depth and intraoperative medication usage are known to contribute to the pathogenesis of POCD. The Bispectral Index (BIS), a measure of anaesthetic depth, and Dexmedetomidine, an alpha-2 adrenergic receptor agonist with neuroprotective effects, have both been suggested as methods to reduce POCD incidence.
Aim of the Study: This study aimed to evaluate the role of BIS-guided anaesthesia and Dexmedetomidine infusion in reducing the incidence and severity of POCD in elderly patients undergoing elective ENT surgeries.
Objectives: To compare the effects of BIS-guided anaesthesia with and without Dexmedetomidine infusion on cognitive function post-surgery and to analyze intraoperative anaesthetic requirements and haemodynamic stability.
Materials and Methods: A total of 120 patients aged 60 years and above, undergoing elective ENT surgeries under general anaesthesia, were randomly assigned to three groups: Group A (standard anaesthesia), Group B (BIS-guided anaesthesia), and Group C (BIS-guided anaesthesia with Dexmedetomidine). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Digit Symbol Substitution Test (DSST), and Trail Making Test (TMT) at baseline, postoperatively on day 3, and at 1-month follow-up. Statistical analysis was performed using SPSS.
Results: The incidence of POCD was significantly lower in Group C (2.5%) compared to Group A (15%) and Group B (7.5%) at the 1-month follow-up (p < 0.05). Group C also showed superior cognitive outcomes in MMSE, DSST, and TMT scores. Intraoperative hemodynamic stability was better in Group C, with fewer hypotensive episodes and reduced anaesthetic consumption compared to the other groups.
Conclusions: The study demonstrates that BIS-guided anaesthesia combined with Dexmedetomidine infusion significantly reduces the incidence and severity of POCD in elderly patients undergoing ENT surgery. These findings suggest that optimizing anaesthetic depth and incorporating Dexmedetomidine may offer neuroprotective benefits, improving cognitive outcomes in this vulnerable population.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Mohammed Naseeruddin Mujahid
Associate professor of ENT, Dept. of ENT, Deccan college of medical Sciences, Hyderabad.
Dr Maroof Ahmed C
Assistant professor of Dept. of Anesthesiology, Deccan College of medical sciences, Hyderabad.
Dr Naseeba Fatima
Associate professor of Anesthesiology, Dept. of Anaesthesia, Deccan College of medical sciences, Hyderabad.