The Effect Of Galanthamine On Early Postoperative Congnitive Dysfunction Of Elderly Patients Undergoing Pulmonary Surgery

Background:Postoperative cognitive dysfunction is being increasingly reported as a complication.We attempted to investigate the effect of galanthamine on early postoperative congnitive dysfunction(POCD)of elderly patients undergoing pulmonary surgery.Methods:Forty ASAⅠ-Ⅱpatients,scheduled for selective non-cardiac thoracic surgery under general anaesthesia in the Second Hospital Affiliated to the Xiangya Medical School of Central South University,were recruited. We excluded patients if they had:a score on the mini-mental state examination(MMSE)at screening of 23 or less;a disease of the central nervous system;were taking tranquillisers or antidepressants;had been admitted for neurological or cardiac surgery;previously undergone neuropsychological testing;were unwilling to comply with the protocol or procedures or were unable to understand the language used;had any severe visual or auditory disorders;were illiterate;had Parkinson's disease; alcoholism,or drug dependence;and if they were not be able to complete tests at 1 week after surgery.The patients were randomly divided into galantamine(G group)and control(C group)subgroups(n=20 in each subgroup).Anesthesia was induced with intravenous midazolam 0.1mg/kg, fentanyl 4μg/kg,propofol 1.5～2.0mg/kg,vecuronium 0.15mg/kg,and maintained with isoflurane inhalation(1%～2%)and intravenous propofol combinated with remifentanil.In the experimental group,the patients received intramuscular galantamine lμg/kg perioperation,while control group receiving normal saline instead of galantamine.The hemodynamic parameters(MAP,HR,SPO2)were under normal level.The volume of liquid and blood received and lost during the operation were also recorded. All patients were admitted in ICU for 24h postoperation.Mini-mental state examination(MMSE)was performed before anesthesia and 7 days after surgery.Results:All the 40 patients were involved in the analysis of results. There were no significant differences between the two groups in age, education level,weight,sex ratio and preoperative MMSE scores.No difference in the volume of liquid and blood that patients lost and received during the operation was found when compared between subgroups. However in all patients,the postoperative MMSE scores in C group patients were significantly lower than that in G group(P＜0.05).The incidence of POCD in G group and C group were 10%and 40%respectively,and there was statistical significance between the two groups(P＜0.05).Conclusion:Galantamine may be effective to lower the incidence of POCD in patients undergoing noncadiac pulmonary surgery.Further study with a sufficient sample size is needed to validate our conclusion.