Preoperativno konzumiranje alkohola, intraoperativno krvarenje i postoperativni bol mogu povisiti rizik od nastanka postoperativnog delirijuma kod bolesnika nakon radikalne retropubične prostatektomije
Sažetak
Uvod/Cilj. Postoperativni delirijum (POD) kod bolesnika nakon nekardiohirurških procedura je često neprepoznat od strane anesteziologa. Cilj naše studije bio je procena učestalosti postoperativnog delirijuma (POD) i mogućih faktora rizika od njegovog nastanka kod bolesnika koji su bili u opštoj anesteziji usled hirurškog zahvata kod radikalne retropubične prostatektomije (RRP). Metode. Nakon dobijanja dozvole Etičkog komiteta, prospektivna studija
obuhvatila je 80 bolesnika, ASA (the American Society of Anestesiology) skor II, koji su planirani za RRP u opštoj anesteziji. Bolesnici su ispunili MMSE test (the Folstein Mini Mental State Exam) preoperativno (veče pred operaciju) i postoperativno (48 sati nakon operacije). U studiji smo ipitivali prisutsvo i težinu delirijuma upotrebom CAM (the Confusion Assessment Method), a stepen agitacije i sedacije primenom RASS (the Richmond Agitation and Sedation Scale). Rezultati. Prosečni preoperativni MMSE skor (28,59 ± 1,04) bio je značajno snižen u postoperativnom period (27,74 ± 1,52; p < 0,0001). Sniženje prosečnog postoperativnog MMSE skora bilo je u korelaciji sa intraoperativnim krvarenjem (p = 0.036). Bolesnici sa višim intenzitetom bola imali su značajno snižen postoperativni MMSE skor (28,75 vs. 26,25; p < 0,001). Kod četiri od pet bolesnika koji su imale delirijum, zabeležen je redovni unos alkohola (> 1 pića dnevno) u preoperativnom periodu (p < 0,0001). Na osnovu RASS skora, agitacija je registrovana kod 13 (16,3%) bolesnika, i kod svih je zabeleženo značajno veće intraoperativno krvarenje u odnosu na ostatak ispitanika (p < 0.001). Zaključak. Rezultati naše studije pokazuju da je u preoperativnoj evaluaciji značajno registrovati preoperativnu konzumaciju alkohola, uzevši u obzir da su svi bolesnici koji su u postoperativnom period razvili POD, preoperativno konzumirali alkohol u većoj količini. Iako veće intraoperativno krvarenje i postoperativni bol višeg intenziteta nisu uticali na učestalost pojave delirijuma, snižavali su MMSE skor, što ukazuje na značaj adekvatnog intraoperativnog tretmana bolesnika u toku hirurgije i anestezije u cilju smanjenja rizika od razvoja POD.
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