Skip to main content
SpringerLink
Log in

Postoperatives kognitives Defizit

Postoperative cognitive dysfunction

  • Fehler und Gefahren
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Das postoperative kognitive Defizit stellt eine schwere bis lebensbedrohliche Komplikation nach einem operativen Eingriff dar. Gründe hierfür sind die erschwerte Mobilisation der Patienten, in deren Folge sich Dekubitalulzera, eine Pneumonie oder eine Venenthrombose entwickeln können. In jedem Fall verlängert sich der stationäre Aufenthalt. Die Genese des postoperativen kognitiven Defizits ist multifaktoriell. Höheres Lebensalter des Patienten und die Art der Operation sind als Risikofaktoren gesichert. Vorerkrankungen des Patienten, wie Diabetes mellitus, Linksherzinsuffizienz, Depressionen oder Alkoholabusus, besitzen ebenso wie die Applikation von Medikamenten mit anticholinerger Wirkung ein hohes Gefährdungspotenzial. Eine spezielle Therapie dieser kognitiven Störung existiert bisher nicht. Obwohl in klinischen Studien die Reduktion eines postoperativen kognitiven Defizits durch präventive Maßnahmen bisher nicht belegt werden konnte, sollten bei prädisponierten Patienten die Anwendung gut steuerbarer Medikamente, die Aufrechterhaltung einer perioperativen Homöostase physiologischer Parameter und die Vermeidung anticholinerger Medikamente beachtet werden.

Abstract

Postoperative cognitive dysfunction is a severe and life-threatening complication after an operation. The mobilisation of the patient is difficult and, therefore, the stay of the patient in the hospital is extended and the resulting immobilisation is associated with further complications (e.g. decubitus, pneumonia, or thrombosis). The genesis of the postoperative cognitive dysfunction has different causes and the highest risk factors are the age of the patient and the character and the duration of the operation. Preexisting diseases, like diabetes mellitus, heart failure, depression or alcohol excess are high risk factors as well as the use of anticholinergic drugs. A specific therapy for this cognitive dysfunction is unknown and, therefore, preventive measures should be used in patients with a preexisting high risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Abildstrom H, Rasmussen LS, Rento P, Hanning CD, Rasmussen H, Kirstensen PA, Moller JT und die ISPOCD group (2000) Cognitive dysfunction 1–2 years after non-cardiac surgery in the elderly. Acta Anaesthesiol Scand 44:1246–1251

    Google Scholar 

  2. Ancelin M-L, Roquefeuil G de, Ledésert B, Bonnel F, Cheminal J-C, Ritchie K (2001) Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br J Psychiatry 178:360–366

    Google Scholar 

  3. Aono J, Mamiya K, Manabe M (1999) Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiol Scand 43:542–544

    Google Scholar 

  4. Browne SM, Halligan PW, Wade DT, Taggart DP (2003) Postoperative hypoxia is a contributory factor to cognitive impairment after cardiac surgery. J Thorac Cardiovasc Surg 126:1061–1064

    Article  CAS  PubMed  Google Scholar 

  5. Canet J, Raeder J, Rasmussen LS et al. (2003) Cognitive dysfunction after minor surgery in the elderly. Acta Anesthesiol Scand 47:1204–1210

    Google Scholar 

  6. Chan D, Brennan NJ (1999) Delirium: making the diagnosis, improving the prognosis. Geriatrics 54:28–42

    Google Scholar 

  7. Chen X, Zhao M, White PF et al. (2001) The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg 93:1489–1494

    Google Scholar 

  8. Fleisher L, Colopy M, Twersky RS et al. (2001) Does functional ability in the postoperative period differ between remifentanil and fentanyl-based anesthesia? J Clin Anesth 13:401–406

    Google Scholar 

  9. Grady RE, Weglinski MR, Sharbrough FW, Perkins WJ (1998) Correlation of regional cerebral blood flow with ischemic electroencephalographic changes during sevoflurane-nitrous oxide anesthesia for carotid endarterectomy. Anesthesiology 88:892–897

    Google Scholar 

  10. Granberg Axèll AIR, Malmros CW, Bergbom IL, Lundberg DBA (2002) Intensive care unit syndrome/delirium is associated with anemia, drug therapy, and duration of ventilation treatment. Acta Anesthesiol Scand 46:726–731

    Google Scholar 

  11. Linstedt U, Meyer O, Kropp P, Bekkau A, Tapp E, Zenz M (2002) Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgery. Acta Anesthesiol Scand 46:384–389

    Google Scholar 

  12. Marcantonio ER, Juarez G, Goldmann L et al. (1994) The relationship of postoperative delirium with psychoactive medications. JAMA 272:1518–1522

    Google Scholar 

  13. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH (1998) The association of intraoperative factors with the development of postoperative delirium. Am J Med 105:380–384

    Google Scholar 

  14. Moller JT, Cluitmans P, Rasmussen LS et al. (1998) Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet 351:857–861

    Article  CAS  PubMed  Google Scholar 

  15. Morrison RS, Magaziner J, Gilbert M et al. (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 58:76–81

    Google Scholar 

  16. Nussmeier NA, Arlund C, Slogoff S (1986) Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology 64:165–170

    Google Scholar 

  17. O’Hara DA, Duff A, Berlin JA et al. (2000) The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 92:947–957

    Google Scholar 

  18. Perry E (1998) Cholinergic mechanisms and cognitive decline. Eur J Anaesth 15:768–773

    Google Scholar 

  19. Rasmussen LS, Steentoft A, Rasmussen H, Kirstensen PA, Moller JT (1999) Benzodiazepines and postoperative cognitive dysfunction in the elderly. Br J Anaesth 83:585–589

    Google Scholar 

  20. Rasmussen LS, Johnson T, Kuipers HM et al. (2003) Does anesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand 47:260–266

    Article  Google Scholar 

  21. Roach GW, Newman MF, Murkin JM et al. (1999) Ineffectiveness of burst suppression therapy in mitigating perioperative cerebrovascular dysfunction. Anesthesiology 90:1255–1264

    Google Scholar 

  22. Schierhout G (2001) Hyperventilation therapy for acute traumatic brain injury (Cochrane Review). Cochrane Library, 4 Oxford: Update Software Ltd.

  23. Snyder-Ramos SA, Gruhlke T, Bauer H et al. (2004) Cerebral and extracerebral release of protein S100B in cardiac surgical patients. Anaesthesia 59:344–349

    Google Scholar 

  24. Tune L, Carr S, Cooper T, Klug B, Golinger RC (1993) Association of anticholinergic activity of prescribed medications with postoperative delirium. J Neuropsychiatry Clin Neurosci 5:208–210

    Google Scholar 

  25. Weiskopf RB, Kramer JH, Viele M et al. (2000) Acute severe isovolemic anemia impairs cognitive function and memory in humans. Anesthesiology 92:1646–1652

    Article  CAS  PubMed  Google Scholar 

  26. Williams-Russo P, Sharrock E, Mattis S et al. (1999) Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology 91:926–935

    Google Scholar 

  27. Wu CL, Hsu W, Richman JM, Raja SN (2004) Postoperative cognitive dysfunction as an outcome parameter of regional anesthesia and analgesia. Reg Anesth Pain Med 29:257–268

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Mainz

    K. Engelhard & C. Werner

  2. Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz

    K. Engelhard

Authors
  1. K. Engelhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Engelhard.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Engelhard, K., Werner, C. Postoperatives kognitives Defizit. Anaesthesist 54, 588–594 (2005). https://doi.org/10.1007/s00101-005-0829-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-005-0829-y

Schlüsselwörter

Keywords

Search

Navigation