Objective: to investigate changes in cognitive functions as a marker of the state of the central nervous system of patients in ophthalmic surgery after surgery for end-to-end keratoplasty to optimize the choice of anesthesia, taking into account the effect of general anesthesia on the state of mnestic functions in the postoperative period. The influence of multicomponent balanced anesthesia methods on the state of cognitive functions in the postoperative period, epidemiology and relevance are
analyzed. 136 patients were examined after surgery for end-to-end keratoplasty under multicomponent balanced anesthesia. The study was conducted during 2017-2019. Statistical processing of the study results was performed using the license package Statistica v.6.1. Distribution of groups depending on the received method of anesthesia: group k (n1 = 45) multicomponent balanced anesthesia according to the scheme: premedication for 40 minutes in / m Sibazon, Fentanyl; v / v Ondasetron, Dexamethasone. Induction by administration of Propofol to obtain a clinical effect and Fentanyl. Staging a laryngeal mask on a background of relaxation; maintenance of anesthesia with oxygen - sevoflurane mixture at low gas flow. Group b included 28 patients, performed a combination of multicomponent balanced anesthesia according to the above method with the addition of blockade of the pterygopalatine fossa. Group d included 32 patients, received multicomponent balanced anesthesia with dexmedetomidine, and excluded Sibazon and Fentanyl. In the db (n31) group, regional anesthesia with dexmedetomidine infusion before surgery was performed. The study took place in 8 stages. Cognitive functions were assessed by neuropsychological testing using a short scale for assessing mental functions, the Luria test, the scale of frontal dysfunction. Analgesia depth control was assessed using the Analgesia Nociception Index, a Bispectral index depth assessment. The average scores of neuropsychological testing of patients the day before were below normal. 6 hours after surgery in group k there was a decrease in all indicators.
Deterioration of indicators was determined during the observation of all scales, a significant proportion of patients maintained a decrease in the level of cognitive functions during the observation. Mean glycemia tended to increase during follow-up. The average amount of Fentanyl used was 5.35 (± 0.26) ml. Patients had a deterioration in cognitive status relative to baseline. In group b, the decrease in cognitive functions in the early postoperative period was less pronounced. Recovery of cognitive functions occurred one week after surgery. When using a regional blockade in the complex of anesthesia, there is a short-term and less pronounced decrease in performance than when using the classical scheme. In group d, the amount of fentanyl used was reduced. Up to 21 days, there was an improvement in cognitive performance compared to surgery. In the db group, the average amount of fentanyl used was 1.4 times less than in the control group. In the early postoperative period, the median rate of assessment of mental and frontal functions decreased by 12.0 and 12.5%, respectively. Restoration of cognitive functions of the level took place the next day. By the end of the observation, there was a significant improvement in cognitive function. Evaluating cognitive functions, the percentage of reduction and the rate of recovery of cognitive functions in patients depended on the chosen method of analgesia. In reducing the amount of fentanyl used, the decrease in cognitive function is less. Cognitive function was less altered with multimodal analgesia and dexmedetomidine with regional anesthesia. Recovery of the cognitive state occurred faster, with the proportion of patients increasing. A comprehensive assessment of cognitive status in ophthalmic surgery patients before surgery was performed. The dependence of the state of cognitive functions after ophthalmic surgery on the method of anesthesia is obtained. The effectiveness of components and their combinations: dexmedetomidine and blockade of the pterygopalatine fossa in order to reduce the effect of anesthesia on cognitive functions in the postoperative period after end - to - end keratoplasty has been substantiated. The scheme of anesthesiological support taking into account dynamics of cognitive functions for the purpose of reduction of negative influence of anesthesia on formation of postoperative cognitive dysfunctions is offered.
