Cognition State Evaluation by N-back in Mustard Gas Casualties: Dexmedetomine versus Remifentanil in Cataract Surgery
,
Abstract
Background: Sulfur Mustard (SM) is an alkylating agent that has been used as a chemical warfare gas during World War II and by Iraqi army in the Iran-Iraq conflict between 1983 and 1988. SM can cause serious organ damages especially ocular, neurologic, coetaneous, bone marrow and pulmonary complications. On the other hand dexmedetomidine is a α2 agonist with sedative and analgesic effect with a short duration half-life. Considering these benefits, usage of dexmedetomidine would be a good choice in ophthalmic outpatient’s surgeries to keep the cognition state in an acceptable condition comparing with other available drugs especially in patients with concurrent chemical burn injury.
Methods: After informed consent, patients with inclusion criteria were randomly divided in to two groups: dexmedetomidine (group D, n=50) and Remifentanil (group R, n=50). Cardiovascular signs, Mini Mental State Examination (MMSE) score were recorded as baseline. Patients received respectively dexmedetomidine by infusion with a loading dose of 0.5µg/kg (during 10 minutes) in group D. The maintenance dose of 0.2µg/kg/hr was then started. Loading dose of remifentanil was given by 0.1µg/kg (during 10 minutes); 5 minutes before local anesthesia in group R and maintenance dose of 0.05µg/kg/min was then started. In Post Anesthesia Care Unit (PACU) after 120 minutes of stopping drug infusions n-back and MMSE tests were performed.
Results: The MMSE score had no statistically difference between two groups before surgery (in subgroup age>=65 P= 0.5, and in subgroup age<65 P= 0.6) but in the PACU the score diverged statistically between two subgroups in age>=65 and age<65 years old respectively (in subgroup age>=65 P<0.0001, and in subgroup age<65 P= 0.03). The results of n-back test showed a more precision and rapidity in working memory in group D. (p<0.001 and p=0.002 respectively).
Conclusion: The result of n-back and MMSE revealed that the cognition state improves better in patients receiving dexmedetomidine comparing with those of remifentanil. Dexmedetomidine is safe for protecting the cognition state especially in patients with borderline respiratory reserve due to chemical burn injury.
Kermany MP, Soltani MH, Ahmadi K, Motiee H, Rubenzadeh S, Nejati V. The impact of anesthetic techniques on cognitive functions after urological surgery. Middle East J Anaesthesiol. 2015; 23(1):35-42.
Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006; 99(4):273-82.
White PF, Freire AR. Ambulatory (outpatient) anesthesia: Anesthesia. In: Miller RD, editor. Miller's Anesthesia. 6th ed. Philadelphia: Churchill Livingstone; 2005. pp. 2589–637
Morgan GE, Mikhail MS, Murray MJ, Larson CP. 3rd ed. New York: McGraw Hill; 2002. Clinical anesthesiology; pp. 882–8.
Birch BR, Anson KM, Miller RA. Sedoanalgesia in urology: A safe, cost-effective alternative to general anaesthesia. A review of 1020 cases. Br J Urol. 1990; 66(4):342-50.
Qian XL, Zhang W, Liu MZ, Zhou YB, Zhang JM, Han L. Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol. 2015; 746:206-12.
Quaedflieg CW, Münte S, Kalso E, Sambeth A. Effects of remifentanil on processing ofauditory stimuli: a combined MEG/EEG study. J Psychopharmacol. 2014; 28(1):39-48.
Mashour GA, Forman SA, Campagna JA. Mechanisms of general anesthesia: From molecules to mind. Best Pract Res Clin Anaesthesiol 2005; 19(3):349-64.
Fodale V, Santamaria LB, Schifilliti D, Mandal PK. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease. Anaesthesia, 2010; 65(4):388-95.
Evered LA, Silbert BS, Scott DA, Maruff P, Laughton KM, Volitakis I, et al. Plasma amyloid beta42 and amyloid beta40 levels are associated with early cognitive dysfunction after cardiac surgery. Ann Thorac Surg. 2009; 88(5):1426-32.
Ardila A. Language representation and working memory with bilinguals. J Commun Disord. 2003; 36(3):233-40.
Owen AM, Mc Millan KM, Laird AR. N-Back working Memory Paradigm: A Meta-Analysis of Normative Function Neuroimaging studies. Human Brain Mapping. 2005; 25:46-59.
Kane MJ, Conway ARA, Miura TK, Colflesh GJH. Working Memory, Attention Control, and the N-Back Task: A Question of Construct Validity. Journal of Experimental Psychology. 2007; 33(3):615-22.
Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002; 95(2):461-6.
Seymour DG, Severn AM. Cognitive dysfunction after surgery and anaesthesia: What can we tell the grandparents? Age Ageing. 2009; 38(2):147-50.
Rödig G, Rak A, Kasprzak P, Hobbhahn J. Evaluation of self-reported failures in cognitive function after cardiac and non-cardiac surgery. Anaesthesia. 1999; 54(9):826-30.
Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al. Hypoglycemia and Outcome in Critically Ill Patients. Mayo Clin Proc. 2010; 85(3): 217-24.
Ni X, Martin-Caraballo M. Differential effect of glutamate receptor blockade on dendritic outgrowth in chicken lumbar motoneurons. Neuropharmacology. 2010; 58(3):593-604.
Weinbroum AA, Szold O, Ogorek D, Flaishon R. The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature. Eur J Anaesthesiol. 2001; 18(12):789-97.
Williams-Russo P, Sharrock NE, Mattis S, Liguori GA, Mancuso C, Peterson MG, et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology. 1999; 91(4):926-35.
Townes BD, Dikmen SS, Bledsoe SW, Hornbein TF, Martin DC, Janesheski JA. Neuropsychological Changes in a Young, Healthy Population after Controlled Hypotensive Anesthesia. Anesth Analg. 1986; 65(9):955-9.
Maghawry KM, El-Agamy AES, Tahir WI, Zein AF. Cerebral oxygen saturation monitoring during hypotensive anesthesia in shoulder arthroscopy: A comparative study between dexmedetomidine and esmolol. Egyptian Journal of Anaesthesia. 2015; 31(1):43-52.
Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg. 2010; 110(1):47-56.
Mohamed S, RamzyShaaban A. The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery. 2014; 30(4):331-8.
| Files | ||
| Issue | Vol 2 No 2 (2016): Spring |
|
| Section | Research Article(s) | |
| Keywords | ||
| mustard gas cognition state n-back Mini Mental State Examination | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
