Impact Of General Anesthesia With Tracheal Intubation And Combined Spinal-epidural Anesthesia On Early Postoperative Cognitive Dysfunction Of Elderly Patients With Urinary Surgery

Objective:To explore the impact of general anesthesia with tracheal intubation and combined spinal-epidural effects of anesthesia on early cognitive impairment in elderly patients.Methods:Under the principle of informed consent and voluntary principles,60 elderly patients,aged 65⁸2 years old,weighing 45⁸0 kg,American Society of Anesthesiologists?ASA?class?or?,hypertension or not,with preoperative Mini-Mental State Examination?MMSE?score?25,scheduled for urinary surgery?Cystoscopic or ureteroscopic lithotripsy,pyelolithotomy,transurethral prostatectomy,transurethral resection of bladder tumor?in No.85 Hospital of PLA from Sep.2016 to Dec.2016,were divided into 2 groups?n=30 each?by random digital table method:general anesthesia?group G?and combined spinal-epidural anesthesia group?group C?.In group G,15 minutes before anesthesia induction,dexmedetomidine 0.5?g/kg was given by intravenous injection pump for 10-15 min.And then,anesthesia was induced with iv injection of midazolam0.05mg/kg,fentanyl 3⁵?g/kg,propofol 2mg/kg,cisatracurium 0.2mg/kg,and maintained withcontinuousinfusionofpropofol2³mg·kg^-1·h^-1,dexmedetomidine0.2⁰.4?g·kg^-1·h^-1,cisatracurium2mg·kg^-1·min^-1,intermittent iv boluses of fentanyl 1²?g/kg.In group C,isobaric 0.5%bupivacaine 10¹5mg was injected into the subarachnoid space over 20 s,the level of anesthesia was simultaneously adjusted,and 1%lidocaine was injected into the epidural space when needed during operation.The general data was documented before surgery and the operation information were recorded during the surgery.And after the operation,the hospitalization expenses were also recorded.Cognitive function was assessed by mini-mental state examination at 1d before operation?T₀?,and 6h?T₁?,24h?T₂?,72h?T₃?,7d?T₄?after operation.MMSE score<24 was defined as POCD,and the occurrence of POCD was recorded.Results:Compared with T₀,MMSE scores were significantly decreased at T₁ in both 2groups?P<0.05?.Compared with group C,at T₁ and T₂,MMSE scores were significantly decreased and the incidence of POCD was significantly increased in group G?P<0.05?.Conclusion:?1?General anesthesia and combined spinal-epidural anesthesia are related to postoperative cognitive dysfunction in elderly patients.urinary surgery,but the effect of combined spinal-epidural anesthesia is less and safer.?2?The incidence of POCD in elderly patients is high,but the duration is short,and most of them can recover in a short time.?3?Combined spinal-epidural anesthesia is worth popularizing because of its low cost and low rate of return on investment.