Comparison of the effects of neostigmine and sugammadex on postoperative early cognitive functions in geriatric patients undergoing hip fracture surgery in regard to frailty state

Cholinesterase inhibitor neostigmine or sugammadex is used to reverse the effect of muscle relaxant agents used in patients under general anesthesia. The effect of sugammadex on cognitive functions is not clear. With the increasing elderly population, frailty appears more frequently as a geriatric problem. It is thought that the better and faster recovery provided clinically by sugammadex may be due to the effect of sugammadex on the CNS by passing through the BBB disrupted by surgery, as well as the neuronal transmission provided by the increase in ACh use. In addition, cyclodextrins are among the supposed mechanisms of action that they can provide neural protection by inhibiting the formation of inflammatory molecules, that the tension receptors of the muscle spindles can be terminations affecting the cortical areas and that they can provide cerebral stimulation in the wakefulness centers with the muscle activation they provide. Based on all these assumptions, our hypothesis was that sugammadex may have a positive effect on early postoperative cognitive functions in geriatric patients undergoing hip fracture surgery, and that frailty may have a role in this effect. In our study, we aimed to compare the effects of neostigmine and sugammadex on postoperative early cognitive functions in patients over 65 years of age undergoing hip fracture surgery in regard to the frailty state. Patients over 65 years of age who will undergo hip fracture surgery under general anesthesia were included in the study. Clinical frailty scale was determined by visiting each patient on-site before the operation. Patients were randomly divided into two groups and standardized according to their education level or mini mental test was performed for the uneducated. Those whose MMT results were below 17 points and those whose CAM test was positive with a score below 23 were not included in the study. Patients' name-surname, protocol number, age, gender, h comorbidity, ASA score, anesthetic drugs to be applied and additional analgesic needs were recorded in the research follow-up form. At the end of the operation, neostigmine or sugammadex was applied as reversal to the patients with TOF. Afterwards, mini mental tests were repeated at postoperative 1st, 6th, 12th, 24th and 48th hours and CAM was applied to all cases. When the findings were evaluated, a significant decrease in cognitive functions was found at the postoperative 1st, 6th and 12th hours in both groups, but the decrease at the postoperative 24th and 48th hours was not statistically significant. There was no difference between patients who were positive for CAM but were diagnosed with POD in both groups. While there was a significant decrease in the cognitive functions of patients with frailty at all times, this decrease was significant only at the postoperative 1st hour in non-frail patients. No better cognitive function could be demonstrated with sugammadex in frail patients compared to neostigmine. Keywords: Cognitive Function, Frailty, Neostigmine, Sugammadex