Prevention of cognitive disorders in the postoperative period in preschoolers

Abstract

Surgeries under general anesthesia may result in reduced cognitive functions in children, which is important for child development Objective. To assess the incidence of cognitive disorders in children aged 3 to 7 years after intraoperative combined balanced anesthesia and to evaluate the efficacy of Cytoflavin in preventing them. Patients and methods. This study included 85 children who had undergone surgery (adenoidectomy and/or tonsillectomy) under general combined balanced anesthesia (sevoflurane, nitrous oxide, rocuronium bromide, fentanyl, and dexamethasone). The patients were randomized into two groups: control group (n = 40) and experimental group, in which children additionally received one infusion of cytoflavin intraoperatively (n = 44). All patients underwent comprehensive testing with the assessment of various cognitive functions before surgery, 24 hours postoperatively, and one month postoperatively. Results. Cognitive disorders were observed in 6%–10% of children after general anesthesia. The main manifestations of cognitive deficits in the postoperative period, such as impaired concentration, were most significant 24 hours postoperatively, but were eliminated one month later. A total of 7.1% of children demonstrated at least 20% decrease of their attention after surgery under general balanced anesthesia (confirmed by at least 3 tests). Six percent of children had a 20% decrease in their memory 24 hours postoperatively (confirmed by 2 tests). Cytoflavin improved cognitive performance 24 hours postoperatively, while patients in the control group had no significant changes. However, administration of cytoflavin had no significant impact on the incidence of cognitive deficit. Further studies are needed to identify children at risk who require prevention of cognitive disorders associated with anesthesia. Key words: anesthesia in children, anesthetics, pediatric surgery, cognitive outcomes, nicotinamide, postoperative cognitive dysfunction, cytoflavin

Post-Surgery Cognitive Dysfunction Diagnostics in Children

“…Опираясь на собственный опыт применения нейропсихологического инструментария для диагностики ПОКД у детей с 3-летнего возраста [23,24], мы представляем обзор используемых когнитивных тестов, а также других методов диагностики, применение которых возможно у детей в отделениях анестезиологии в условиях ограниченного времени и ресурсов.…”

“…Тест широко применяется в научных исследованиях невербального интеллекта и зрительно-пространственного гнозиса у детей, отличается непродолжительным временем тестирования, является привлекательным и доступным материалом для детей дошкольного возраста. В нашей практике имеется опыт применения теста для диагностики ПОКД у детей в возрасте от 3 лет [23,24].…”