The effects on cognitive function of sedation with propofol and propofol , ketamine combination in elderly patient with spinal anesthesia

SUMMARYAim of the study: Nowadays, the elderly patients frequently undergo surgeryand get anesthesia because of those procedures. POCD has a tendency to occur in shorttime period after surgery and may last for months; sometimes it may be a permanentand unwanted condition. It reduces patient?s life quality and increases hospital length ofstay. In this study, we aimed to compare the effects of propofol and propofol-ketaminemixture sedation on hemodynamics and cognitive functions of the elderly patientsduring spinal anesthesia for urologic surgery.Material and methods: After Ethics Committee approval and patient?s writtenconsent, ASA I-III 60 patients aged more than 65 years whom were undergone electiveurologic surgery included in this study. sMMT was applied to all patients beforeoperation by researcher who doesn?t know the groups. The patients were divided to twogroups: propofol (Group P, n=30) and propofol-ketamine combination (Grup K, n=30).The patients were monitorised with ECG, NIBP, SpO2 and BIS. After spinal anesthesia,propofol was given with 0.5 mg/kg iv bolus then infused with a dose of 1.5 mg/kg/h forgroup P. Propofol was given with 0.4 mg/kg iv bolus then infused with a dose of 1.2mg/kg/h and ketamine was given with 0.1 mg/kg iv bolus then infused with a dose of0.3 mg/kg/h for group K. Hemodynamic and respiratory data was recorded during thestudy. Sedation level was monitorised with BIS and RAMSAY sedation scale. After theoperation infusions were stopped and the patients were monitorised in the PACU untiltheir modified Aldrette score was reached to 9. The emergence time was recorded.sMMT was re-applied within first 24 hours and at the third postoperative day with sameresearcher.42Results: The heart rate, systolic and mean blood pressure values of the twogroups were decreased compared to the initial values. There was no statisticallysignificant difference between two groups for sMMT values which were applied atpreoperative and postoperative 1st and 3rd days. According to intra-group comparisons;the similar statistically significant important results were found for each group.Preoperative vs. postoperative 1st day and postoperative 1st day vs. postoperative 3nd dayvalues were different (p< 0.001). There was no significant difference betweenpreoperative sMMT and postoperative 3nd day values (p < 0.25). The injection pain washigher in group P than group K (p<0.05).Conclusion: The elderly patients with spinal anesthesia and sedated withpropofol or propofol-ketamine combination whom were undergone elective urologicsurgery included in this study. After sedation with propofol-ketamine combination theemergence times of the patients were longer and BIS values were higher than propofolgroup. There were no difference for hemodynamic values and cognitive functions of thepatients.Key Words: aged, anesthesia, spinal, propofol, ketamine, cognitive dysfunction.