Downloaded 252 times
Uploaded bySimon Richard
Postoperative cognitive dysfunction (pocd) in the (1)
Postoperative Cognitive Dysfunction (POCD) in elderly patients is characterized by changes in personality, social integration, and cognitive abilities following surgery. Studies have found POCD incidence rates ranging from 10-60% in elderly patients after various surgeries like general surgery, orthopedic surgery, and cataract surgery. POCD is thought to be caused by physiological effects of anesthesia like hyperventilation and hypotension, as well as genetic factors and surgery-related stress. Both general anesthesia and regional anesthesia may contribute to POCD, though results from studies comparing the two have been mixed. Preoperative, intraoperative, and postoperative factors like the type and duration of surgery, anesthesia drugs used, pain, and hypoxia may
More Related Content
Similar to Postoperative cognitive dysfunction (pocd) in the (1)
Postoperative cognitive dysfunction (pocd) in the (1)
- 1. Postoperative Cognitive Dysfunction (POCD)in the elderly By Ajay Moderator: Dr YOGA
- 2. POCD in theElderly Changes in personality Changes in social integration Changes in cognitive powers and skills
- 3. Incidence Seymour ’86 Williams’92Linn ’53 Francis’90 General Surgery Ortho Cataract Medical Hospitalization 10-15% (All patients 5-10%) 28-60% 1-3% 25-50%
- 4. History 1955,Bedford 1961,Simpson 1967,Blundell1970,Finnish study recommended to confine operations to necessary cases concluded that anaesthesia had no effect and recorded benefits of surgery. believed anaesthetic drugs, fever etc caused POCD showed deterioration in 8% of elderly patients
- 5. Why does POCDoccur? Physiologic effects of the anaesthetics: hyperventilation, hypotension or hypoxia Role of catecholamines or cholinergic transmission Genetic markers from dementia studies
- 6. Is POCD causedby GA or Regional? Study n Operation Age (yrs) POCD Difference Hole’80 60 THR 56-84 Yes Yes Kaarh’82 60 CAT >65 Yes Yes Riis ‘83 30 THR >60 Yes No Bigler’85 40 Hip >60 No No Chung’87 44 TURP 60-93 Yes Yes Hughes’88 30 THR 50-80 Yes Yes Ghonei’88 105 Joint 25-86 Slight No Asbjer’89 40 TURP 60-80 Yes No Jones’90 146 THR/TKR >60 No No Nielson’90 60 TKR 60-86 No No Camp ‘93 169 CAT 65-98 No No Willia’96 262 TKR >40 Yes No
- 7. Does GA perse cause POCD? • Subtle changes in all ages • Larger deficits with surgery of shorter duration Study n Operation Age(Yrs) Effects Smith ‘86 85 Ortho/Gynae./General 50-69 Yes Chung ‘90 40 Cholecystectomy 25-83 Yes Smith ‘91 112 TURP 48-88 Yes Tzabar 54 General 19-70 Yes
- 8. POCD in cardiacsurgery Study n Surgery Age(yrs) Short-term Long-term Savageau’82 245 CABG/Valve 25-69 28% 24% Shaw’87 312 CABG 31-70 Yes NA Townes’89 90 CABG 40-59 Yes 11-31% McKhann’97 172 CABG 41-86 9-30% 11-33%
- 9. POCD in cardiacsurgery Limited auto-regulatory capacity Hypothermia Intraoperative hypotension Loss of pulsatile flow Macro or micro-embolization Particulate cellular aggregates
- 10. Common drugs causingPOCD Minor Tranquilizers Anti -hypertensives Diuretics Beta blockers Major Tranquilizer Analgesics Others Diazepam Methyldopa Hydrochlor- thiazide Propranolol Haloperidol Acetyl salicylic acid Cimetidine Flurazepam Reserpine Thorazine Meperidine Insulin Meprobamate Thioridazine Amoxapine Oxazepam Amantidine Chlorazepate
- 11. Summing up theaetiologic factors Preoperative Intraoperative Postoperative Physiologic and Pathologic Type of surgery Hypoxia Drugs Duration of surgery Hypocarbia Endocrine and metabolic Anaesthetic drugs Pain Mental status Type of anaesthesia Sepsis Sex Complications during surgery Electrolyte or metabolic
- 12.
- 13.
- 14. Prevention Preoperative Intraoperative Postoperative Detailedhistory of drugs Adequate oxygenation and perfusion Treat pain Evaluation of medical problems Correct the electrolyte imbalance Reassure patient and family Detections of sensory or perceptual deficits Adjust drug doses Keep patient informed and oriented Mental preparation prior to surgery Minimize the variety of drugs Quite surrounding Neuropsychologic testing Avoid atropine, flurazepam, scopolamine Well-lit cheerful room
- 15. Management Manage with extravigilance Delirium may signal onset of pneumonia, sepsis, MI Reduce or stop risk associated drugs Haloperidol- the drug of choice ; Droperidol; Chlorpromazine Diazepam-useful in delirium tremens Thiamine-Korsakoff’s psychosis Avoid muscle relaxants or physical restraints; may need ABD control Psychiatric or psychological referral Physiotherapy and occupational therapy
- 16. References C. Dodds andJ.Allision. Postoperative deficit in the elderly surgical patient.BJA 1998 Smita S. Parikh and Frances Chung.Postoperative Delirium in the Elderly.Anesth Anal 1995 Khwaja et al.Preoperative Factors Associated with Postoperative Changes in Confusion Assessment.Anesth Anal 2002
- 17. Thank you verymuch!