Preoperative cognitive screening in vascular surgery patients
Authors:
M. Horáček
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole
Published in:
Anest. intenziv. Med., 30, 2019, č. 2, s. 60-67
Category:
Overview
Objective: To determine the proportion of patients with possible cognitive dysfunction in a population of seniors ≥ 60 years undergoing elective vascular surgical procedures at the pre-anaesthetic visit, and to examine if there is a difference in cognitive functions among individual categories of vascular surgical procedures. The secondary aim was to find if such cognitive testing is feasible and acceptable for patients.
Design: Prospective, observational trial.
Setting: Department of vascular surgery at a teaching hospital.
Materials and methods: Following ethical board approval, consecutive patients ≥ 60 years of age planned for elective vascular surgical procedures were approached between July 1st 2017 and June 30th 2018. Exclusion criteria: Documented dementia or mental retardation, serious disorders of senses, inability to use the dominant hand, language barrier. To determine the cognitive function, a short screening Clock-in-the-Box (CIB) test was used.
Outcome parameter: The proportion of patients with possible cognitive dysfunction was defined by CIB score ≤ 5 (range 0-8). The significance of differences among individual categories of surgical procedures was evaluated with χ2-test, P ≤ 0.05.
Results: 122 patients were approached, of whom 100 were analysed, 63 of them male, mean age 70.7 ± 7 years, education mostly lower than completed secondary, ASA 3. Possible cognitive dysfunction was identified in 34 patients, the differences between the surgical categories (aorta, arterial reconstruction on the lower extremities, carotid endarterectomies, varicose veins) were not significant. CIB test during the pre-anaesthetic visit was feasible and not a burden for patients who considered it useful and would agree to it in future, if necessary.
Conclusion: One third of seniors undergoing elective surgical vascular procedures show pre-existing possible cognitive dysfunction based on a clock-drawing (Clock-in-the-Box) test. The test is sufficiently short, feasible during the pre-anaesthetic visit and acceptable for the patients.
Keywords:
cognitive functions – pre-anaesthetic evaluation – clock-drawing test – Clock-in-the-Box test
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
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