ABSTRACT
BACKGROUND: Transient cognitive dysfunction after general anesthesia is a frequent finding among elderly patients. The aim of this study was to evaluate whether the use of physostigmine may enhance recovery from general anesthesia in elderly patients. METHODS: Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged >65 years old who were scheduled for a laparoscopic cholecystectomy received either 2 mg physostigmine in 250 mL N/S 0.9% (Physo group) or 250 mL N/S 0.9% placebo (Control group) after induction of anesthesia via slow IV infusion over 45 minutes. This experiment was performed as a prospective, randomized, double-blinded study. Patients were assessed for sedation, orientation, ability to sit, and ability to pass the "picking up matches" test at 15 minutes, 8 hours, and 24 hours postoperatively. Patients were also evaluated for pain using the visual analogue scale (VAS) score both at rest and with movement. RESULTS: The time to extubation was significantly shorter in the Physo group than in the control group (8.0±2.7 vs. 9.8±3.6 min, P=0.012). The time required to pass the "picking up matches" test was also shorter for the Physo group at all of the time points postoperatively (15 minutes postoperatively: 18.0±7.1 vs. 24.6±11.6 sec, P=0.003, 8 hours postoperatively: 11.8±3.9 vs. 16.0±6.0 sec, P<0.001, 24 hours postoperatively: 8.8±3.4 vs. 11.2±4.7 sec, P=0.008). Evaluations of patient orientation and sedation were similar between the experimental and control groups. The VAS score and analgesic requirement were decreased in the Physo group compared to the control group during the first postoperative day. The ability to sit after extubation was also increased in the Physo group at both 15 minutes (P=0.001) and 8 hours postoperatively (P<0.001). CONCLUSION: The intraoperative infusion of physostigmine enhances alertness, coordination, manual dexterity and mobilization after general anesthesia in elderly patients, but physostigmine administration does not affect orientation or sedation.
Subject(s)
Anesthesia, General , Cholinesterase Inhibitors/therapeutic use , Physostigmine/therapeutic use , Postoperative Period , Aged , Anesthesia Recovery Period , Attention/drug effects , Blood Pressure/drug effects , Cholecystectomy, Laparoscopic , Consciousness Monitors , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Male , Pain Measurement , Psychomotor Performance/drug effectsABSTRACT
UNLABELLED: Purpose of the study is the research of the diagnostic value of the determination of Troponin T in relation with the other cardiac enzymes in patients who underwent extracardiac surgery operation. METHODS: 42 pts (M = 24, F = 18, mean age 51.7 +/- 17 years) who underwent a surgery operation were studies. For all pts serum enzyme CPK, CPK MB, SGOT and Troponin T was determined 24 hours before and after the operation. RESULTS: increased value of CPK was observed in all patients. In 14.3% of pts was found abnormal value of CPK. In 1 pt CPK MB was found increased. In no one of the above pts was observed an increased value of Tr-T. No one of the pts had ECG changes and clinical symptoms indicative of ischemic heart disease. CONCLUSIONS: these results suggest that the determination of Tr-T in serum is more useful diagnostic index for myocardial cell injury in pts who underwent an extracardiac surgery because is not detected in skeletal muscle injury.
