Influence of Sedation with Dexmedetomidine on Oxidative Distress During Delirium Developed Following Severe Polytrauma

Bershadsky, F. F.; Гребенчиков, О. А.; Yershov, A. V.; Лихванцев, В. В.; Magomedov, M.A.

doi:10.15360/1813-9779-2019-4-11-20

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Крім того, даний стан характеризується розвитком гіпоксії, яка має як гострі, так і відстроковані наслідки для організму. У випадку поєднання зазначених патологій -політравми та хронічного алкоголізму з синдромом відміни алкоголю (СВА), виразність біохімічних порушень значно поглиблюється [6]. Останнім часом визначено, що превалювання прооксидантних факторів призводить до розвитку окисного стресу, прогресування якого за фізіологічних умов обмежується наявністю ферментних та неферментних систем антиоксидантного захисту, зокрема -супероксиддисмутази (СОД), каталази, відновленого глутатіону (GSH), глутатіонпероксидази, пероксиредоксинів, глутатіонредоксинів і гемоксигенази [7].…”

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The Dynamic of Indicators of Lipid Peroxidation and Antioxidant Protection Status in Patients With Polytrauma and Alcohol Withdrawal Syndrome Complicated by Alcohol Delirium

Омельченко-Селюкова¹

2021

RS Global - World Science

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Injuries are one of the leading causes of death and disability in the world. It is known that from 25% to 85% of patients are in a state of alcohol intoxication during hospitalization in the polytrauma department, 5-20% of them develop alcoholic delirium as a complication of alcohol withdrawal.The aim of the study was to analyze the indicators of lipid peroxidation and antioxidant protection in patients with moderate polytrauma and with a state of alcohol withdrawal complicated by alcoholic delirium, depending on the method of sedation. Material and research methods. The study included 80 patients with polysystemic trauma of moderate severity and with a state of alcohol withdrawal complicated by alcoholic delirium. The median age was 45 years [39-54]. Patients in Group 1 (n = 40) were given dexmedetomidine as a sedation method, and in Group 2 (n = 40) they used sedation with diazepam according to the symptom-trigger protocol. The content of the main indicators of the oxidative system was determined in the serum of patients: active products of thiobarbituric acid, diene conjugates, 8-isoprostane to assess the intensity of lipid peroxidation. The state of the antioxidant system was assessed by the content of superoxide dismutase, catalase, glutathione peroxidase. Conclusions. The use of dexmedetomidine for sedation of patients with alcohol withdrawal and alcoholic delirium and polytrauma reduces the manifestations of lipid peroxidation due to faster recovery of enzyme systems of antioxidant protection.

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The Dynamic of Indicators of Lipid Peroxidation and Antioxidant Protection Status in Patients With Polytrauma and Alcohol Withdrawal Syndrome Complicated by Alcohol Delirium

Омельченко-Селюкова¹

2021

RS Global - World Science

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Impact of General Anesthesia and Antioxidants on Cognitive, Static and Locomotor Functions During Laparoscopic Cholecystectomy

Moroz

Долгих

Karpitskaya

2022

Obŝaâ reanimatologiâ

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Aim of the study: to reduce cognitive impairment during laparoscopic cholecystectomy by perioperative administration of drugs with antihypoxic and antioxidant effects under the control of stabilography. Materials and methods. We studied the effect of general anesthesia and antioxidants on cognitive, static and locomotor functions during laparoscopic cholecystectomy. We studied 90 patients with acute calculous cholecystitis randomized into three experimental groups (n=30, each group). The control group was composed of 24 healthy individuals. Group 1 patients received no antioxidants, group 2 patients received the combination antioxidant drug (sodium fumarate+sodium chloride+potassium chloride+magnesium chloride) in the post-operative period, and group 3 patients received methylethylpyridinol. The patient groups were comparable in sex, age and type of inflammatory and destructive process in the gallbladder. Surgical intervention was performed under endotracheal anesthesia. Premedication with atropine and promedol was given, and anesthesia induction was carried out with propofol, fentanyl and suxamethonium. Sevoflurane, fentanyl andcisatracurium were employed to maintain anesthesia, analgesia and myorelaxation, respectively. The patients were examined before surgery, 24 and 48 hours after surgery. In the groups of patients who received antioxidant therapy, blood sampling for hematological and biochemical examinations was performed 30 min after the administration of antioxidants. Stabilographic studies and MoCA test (Montreal Scale) were performed before antioxidant administration prior to surgery and after surgery, on days 2 and 3. Results. Neuropsychological testing revealed postoperative cognitive dysfunction on standard therapy which included impaired attention and concentration, executive function, memory, speech, visual constructional skills, abstract thinking, counting, and orientation (21 points on the MoCA scale versus 28–30 points for normal). We found that the pathogenetic factors of cognitive dysfunction included insufficient antioxidant protection, decreased TNF-α and elevated interleukin-18 levels along with an increased level of C-reactive protein in plasma, which manifested as activation of free-radical oxidation processes and reduced antioxidant system and performance of nonspecific resistance. Perioperative use of the combination antioxidant drug and methylethylpyridinol antioxidants reduced the frequency and severity of postoperative cognitive impairment in patients after laparoscopic cholecystectomy. Conclusion. The most important pathogenetic factors of cognitive dysfunction after laparoscopic cholecystectomy include activation of free-radical oxidation, reduction of antioxidant defense system performance and lack of nonspecific resistance factors. Adding the combination antioxidant drug or methylethylpyridinol to the standard therapy reduces the intensity of radical oxygen species generation, maintains the antioxidant potential, activates production and secretion of nonspecific resistance factors, preventing the development and reducing the severity of cognitive disorders in the perioperative period. Neuropsychological testing and stabilographic examination allow identifying the risk of cognitive disorders in patients after laparoscopic cholecystectomy and provide a rationale for the use of antioxidant therapy for their prevention.

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Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)

Ermokhina,

Kuzovlev,

Davydov

et al. 2024

Vestn. anesteziol. reanimatol.

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The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).

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Influence of Sedation with Dexmedetomidine on Oxidative Distress During Delirium Developed Following Severe Polytrauma

Cited by 3 publications

References 21 publications

The Dynamic of Indicators of Lipid Peroxidation and Antioxidant Protection Status in Patients With Polytrauma and Alcohol Withdrawal Syndrome Complicated by Alcohol Delirium

The Dynamic of Indicators of Lipid Peroxidation and Antioxidant Protection Status in Patients With Polytrauma and Alcohol Withdrawal Syndrome Complicated by Alcohol Delirium

Impact of General Anesthesia and Antioxidants on Cognitive, Static and Locomotor Functions During Laparoscopic Cholecystectomy

Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)

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