Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Gkliatis Emmanouil
Dissertation committee:
Χρυσούλα Στάικου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ (επιβλέπουσα)
Κασσιανή Θεοδωράκη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αικατερίνη Μελεμενή, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Άντεια Παρασκευά, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αθανασία Τσαρουχά - Δημητροπούλου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μαρτίνα Ρεκατσίνα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Τσακωτός, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επάνοδος της γνωσιακής λειτουργίας και χαρακτηριστικά ανάνηψης μετά από γενική αναισθησία σε ασθενείς με σύνδρομο Down. Συγκριτική μελέτη μεταξύ σεβοφλουρανίου και δεσφλουρανίου
Translated title:
Cognitive recovery and recovery characteristics after general anesthesia in patients with Down syndrome. Comparative study between sevoflurane and desflurane
Summary:
Down syndrome (DS) is the most common chromosomal abnormality in humans, caused by the presence of a full or partial third copy of chromosome 21. It is associated with a variety of birth defects and diseases, including developmental, neurological and neurotransmitter alterations and intellectual disability (ID). The improvement in medical care over the years has significantly increased the life expectancy of individuals with DS, and survival into adulthood is now reasonably expected.
These patients may be unable to comprehend the purpose of any medical intervention and it is difficult to cooperate even for minor surgical procedures. Within this context, dental treatment for DS patients with ID is often performed under day care general anesthesia.
Anesthetic drugs may transiently impair patients’ cognitive function and mental status postoperatively, thus delaying their discharge from hospital, especially in day case surgery. Rapid recovery from anesthesia significantly contributes to fast-tracking through postoperative recovery steps and discharge, increases patient comfort and satisfaction, while reducing financial costs and nursing workload in ambulatory care settings
The present randomized, double-blind, parallel-group study included fifty-seven consecutive DS patients randomly assigned to receive either desflurane or sevoflurane for maintenance of anesthesia for dental care surgery. The primary outcome measure was the early postoperative cognitive function, as assessed with the Prudhoe Cognitive Function Test (PCFT) which is designed to “quantitatively” measure cognitive function in people with any degree of ID. The secondary outcome measures were related to recovery characteristics.
Regarding the primary outcome, our results demonstrated that early postoperative cognitive function scores were higher when anesthesia was maintained with desflurane. The difference was more apparent 90 min after recovery, but remained significant for at least 4 h.
Desflurane was also found superior in terms of recovery times. Finally, the discharge criteria from both PACU and hospital were fulfilled earlier when desflurane was used.
We concluded that desflurane may be superior to sevoflurane in terms of faster recovery and better preserved postoperative cognitive function in DS patients undergoing dental surgery. Thus, we suggest that desflurane, as part of a multimodal anesthetic approach, could be a useful agent to enhance fast-tracking and early discharge from hospital of ambulatory patients with ID.
Main subject category:
Health Sciences
Keywords:
Sevoflurane, Desflurane, Down syndrome, Anesthesia
