COGNITIVE DECLINE AND ANESTHESIA CHOICE IN ELDERLY SURGICAL PATIENTS

Abstract

Background: Elderly patients are exposed to a major worrisome risk of cognitive decline after medical procedures. Postoperative delirium (POD) together with postoperative cognitive dysfunction (POCD) frequently occur after surgeries while impacting both recovery and long-term quality of life. The decision regarding anesthesia methodology between general and regional and local methods affects patient mental performance results. The selection of appropriate anesthesia for elderly patients requires special attention because it determines the optimal care delivery during surgery.

Objectives: The study examines how different anesthesia methods (general with regional or local) affect elderly surgical patients' cognitive functions while identifying which anesthesia methods help lower the likelihood of POD and POCD.

Study design: A prospective study.

Place and duration of study. Department of Surgery QHAMC, Nowshera Medical college ,Nowshera from jan 2021 to june 2021

Methods: This study included 200 elderly surgical patients aged 65 years and above who underwent elective surgery. The research team randomly determined the anesthesia type for patients between general, regional and local. The researchers evaluated initial cognitive capacity by administering the Mini-Mental State Examination (MMSE) to patients. The assessment of postoperative cognitive status occurred at both 1 week and 1 month after the surgical procedure. The study used mean age with standard deviation joined by p-values to evaluate cognitive variations between anesthesia groups.

Results: Two hundred patients with 73.4 years median age and 6.2 years standard deviation participated in the study. Total postoperative cognitive dysfunction occurred in 12% of patients receiving regional anesthesia whereas general anesthesia led to POD in 24% and POCD in 18% of patients (p < 0.05). Cognitive decline was most minimal in patients who received local anesthesia as the incidence of POD reached 5% with POCD occurring in 3% of patients (p < 0.01). The patients who received general anesthesia experienced a substantial decline in cognitive scores that measured 2.5 points yet patients under regional (0.8 points) and local (0.3 points) anesthesia showed minimal cognitive changes. The research outcomes indicate that anesthesia methods relate to subsequent cognitive results after surgery.

Conclusion: The selection of anesthesia has a direct impact on the cognitive performance of elderly patients after surgery. Closer examinations show that regional and local anesthesia result in fewer cases of POD and POCD than general anesthesia. The selection of anesthesia should depend on patient age alongside baseline cognitive status and surgical needs to improve postoperative recovery as well as quality of life. More study is essential to develop procedures which maximize cognitive performance amongst elderly patients at risk.