RESUMEN
Purpose of the study - to assess the level of cognitive disorders in gerontological patients of the urological profile, depending on the use of sedation in the intraoperative period. A prospective cohort study was performed on 60 gerontological patients diagnosed with BPH II-III stages. Two groups were formed: conscious patients and patients using sedation. Operation - bipolar transurethral enucleation of the prostate (BTUEP). Determination of the depth of sedation with propofol was carried out according to the Ramsey sedation scale in the BIS-monitoring mode. Registration of cognitive status was carried out on the basis of the Montreal Cognitive Function Scale and the Hamilton Depression Scale. The level of cognitive functions of patients in both study groups before surgical treatment indicated the presence of mild impairments according to the Montreal Cognitive Function Scale and the Hamilton Depression Scale. In the group using sedation in patients, a statistically significant decrease (p<0,005) in the score for three items of the Hamilton depression scale was determined in comparison with the group with preserved consciousness in patients: average insomnia (χ2=5,07), working capacity and activity (χ2=4,17), mental anxiety (χ2=4,43). Anesthesia, including spinal anesthesia and sedation controlled by BIS-monitoring, in gerontological patients during BTUEP provides a positive effect on the cognitive functions of patients and reduces the manifestations of depressive symptoms according to the results of clinical interviews using the Montreal Cognitive Assessment Scale and the Hamilton Depression Scale.
Asunto(s)
Anestesia , Anestesiología , Disfunción Cognitiva , Propofol , Masculino , Humanos , Anciano , Estudios Prospectivos , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiologíaRESUMEN
The aim of the study was to evaluate the effectiveness of the use of tranexamic acid in the prevention of intraoperative hemorrhagic complications in geriatric patients with bioply transurethral resection of the prostate (BTURP). The patients were divided into 2 groups by the envelope method. Patients of the first group (control group, n=42) did not receive tranexamic acid infusion. Patients of the second group (main group, n=42) received pre-intraoperative infusion of tranexamic acid at a dose of 2 mg/kg. All patients underwent BTURP on endoscopic equipment according to the standard technique under spinal anesthesia. The groups were compared according to the following criteria: the volume of intraoperative blood loss, the level of erythrocytes, platelets and hemoglobin, indicators of hemostasis, thromboelastography before and after surgery. It was established that the perioperative use of tranexamic acid allowed to significantly reduce the volume of blood loss in BTURP. The method of thromboelastography, due to quantitative and qualitative characteristics, is able to assess how the effectiveness of the use of a fibrinolysis inhibitor is achieved.