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Vol. 43. Num. 1.
Pages 1-60 (January - February 2019)
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Vol. 43. Num. 1.
Pages 1-60 (January - February 2019)
Original
DOI: 10.1016/j.medine.2019.01.001
Effects of deep sedation under mechanical ventilation on cognitive outcome in patients undergoing surgery for oral and maxillofacial cancer and microvascular reconstruction
Efectos de la sedación profunda bajo ventilación mecánica sobre los resultados cognitivos en pacientes sometidos a cirugía por cáncer oral y maxilofacial con reconstrucción microvascular
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Y. Teradaa, S. Inouea,
Corresponding author
seninoue@naramed-u.ac.jp

Corresponding author.
, M. Kondaa, J. Egawaa, J. Uedab, T. Kiritab, M. Kawaguchia
a Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan
b Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522, Japan
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Figures (2)
Tables (4)
Table 1. Patient characteristics, intraoperative data, duration of sedation, and doses of analgosedatives.
Table 2A. The number of patients showing a decline of 20% from pre-cognitive evaluation scores.
Table 2B. The number of patients showing a decline of each cognitive test.
Table 3. Cognitive test results at baseline and three weeks postoperatively.
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Abstract
Objective

Cognitive impairment after intensive care unit (ICU) admission is becoming increasingly recognized. High-dose deep sedation has been suggested to play an important role in the development of cognitive impairment. However, the impact of heavy sedation as a single cause in the development of cognitive impairment in ICU patients remains unclear. In this study we investigated whether a three-day deep sedation protocol could reduce cognitive function in mechanically ventilated non-critical patients.

Design

A prospective observational study was carried out.

Patients

A total of 17 surgical patients were studied.

Intervention

None.

Variables of interest

Cognitive function before and after ICU admission.

Results

Thirty-one patients requiring three days of sedation after microvascular reconstruction were initially enrolled in the study. Sedation in the ICU was maintained with propofol and dexmedetomidine combined with fentanyl. Cognitive function was assessed using a battery of 6 neuropsychological tests two days before surgery and three weeks after surgery. Finally, a total of 17 patients were included in the analysis. Cognitive impairment (defined as a decline of >20% from the pre-admission cognitive evaluation scores in at least two of 6 tests) was observed in 5 of the 17 patients (29%). However, there were no significant differences between the pre- and post-admission cognitive evaluations in 6 tests.

Conclusions

Middle-term cognitive function can be impaired in some patients subjected to deep sedation during several days following maxillary–mandibular oral surgery with microvascular reconstruction.

Keywords:
Sedation
Intensive care unit
Cognitive impairment
Cognitive test
Sedatives
Resumen
Objetivo

Cada vez existe un mayor consenso sobre la afectación cognitiva tras el ingreso en la unidad de cuidados intensivos (UCI). Se ha sugerido que la sedación profunda con dosis elevada desempeña un papel importante en el desarrollo de la alteración cognitiva. Sin embargo, todavía existen dudas sobre el impacto de este tipo de sedación como causa única del desarrollo de alteraciones cognitivas en pacientes ingresados en la UCI. En este estudio, investigamos si la aplicación de un protocolo de sedación profunda durante 3 días disminuía la función cognitiva en pacientes no críticos bajo ventilación mecánica.

Diseño

Se llevó a cabo un estudio observacional prospectivo.

Pacientes

Se estudió a un total de 17 pacientes quirúrgicos.

Intervenciones

Ninguna.

Variables de interés

Función cognitiva antes y después del ingreso en la UCI.

Resultados

En este estudio se incluyó inicialmente a 31 pacientes que requerían 3 días de sedación tras una reconstrucción microvascular. Se mantuvo la sedación en la UCI con propofol y dexmedetomidina en combinación con fentanilo. Se evaluó la función cognitiva mediante un grupo de 6 pruebas neurofisiológicas antes de la intervención y 3 días después de esta. Por último, se incluyó a un total de 17 pacientes en el análisis. Se observó alteración cognitiva (definida como una reducción>20% frente a las puntuaciones de la evaluación cognitiva previa al ingreso en al menos 2 de las 6 pruebas) en 5 de los 17 pacientes (29%). Sin embargo, no se observaron diferencias significativas entre las evaluaciones previas y posteriores al ingreso en 6 pruebas.

Conclusiones

La función cognitiva a medio plazo puede verse afectada en algunos pacientes sometidos a sedación profunda durante varios días tras una cirugía oral maxilar-mandibular con reconstrucción microvascular.

Palabras clave:
Sedación
Unidad de cuidados intensivos
Alteración cognitiva
Prueba cognitiva
Sedantes

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