Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

Abstract

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients.
 Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated.
 Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001).
 In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery.
 According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001).
 On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected.
 Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient.
 According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period