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23 April 2009

Delirium and postoperative cognitive dysfunction after general anesthesia

Beata SaniovaABDEF, Michal DrobnyABDE, Miroslav SulajFG

Med Sci Monit 2009; 15(5): CS81-87 :: ID: 869631

Abstract

Background
General anesthesia is characterized by unconsciousness, analgesia, muscle relaxation, and depression of reflexes, generally in response to the administration of chemical agents that induce reversible unconsciousness. Study of the cognitive neuroscientific basis of general anesthesia involves evaluation of the effect of anesthetic agents on consciousness and the brain mechanisms underlying cognitive function. Central nervous system dysfunction after anesthesia and/or surgery can occur at any age but is a particular issue for elderly patients. Studies of delirium and postoperative cognitive dysfunction have been published in many countries since the end of the last century. We present a discussion of delirium disorders and a review of the literature.
Material and Method
We also present case reports for 2 patients who underwent general surgery for epilepsy. The first patient experienced postoperative visual illusions, hallucination, and time and space disorientation. The second patient experienced a postoperative zombie-like delirium state. The status of both patients was improved in response to treatment with methylprednisolone. The first patient also received amantadine sulfate, and the second patient received antiepileptic drugs.
Results

Conclusions
The brain is the main target organ for anesthetic and adjuvant drugs, and age-associated changes in the brain have important implications with respect to general anesthesia. Anesthetists and surgeons have suspected for many years that some patients suffer a postoperative decline in cognitive function. The condition generally has a good outcome because oxidative nerve cell derangements and neurotransmitter imbalances are transient.

Keywords: Epilepsy - surgery, Cognition Disorders - chemically induced, Delirium - chemically induced, Child, Anesthesia, General - adverse effects, Postoperative Period

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750