The article was written by BSCK II. Nguyen Trung Thanh – Anesthesihetist – Analgesic – Surgical Anesthesio – Share99 Central Park International Health Hub
In addition to neurological problems that occur after surgery such as slow or unconscious wake-up are associated with drug use or pathology and abnormalities in the central nervous system (including orientation disorders, mental disorders or movement disorders and myeloid reflexes) that occur when we are awake, we also have problems with coma and very common post-surgery mental disorders in adults. age.
Advances in anesthesia as well as surgery have increased safety in older anesthesia, but besides the success of surgery, it has been found that the incidence of coma and post-caesarean perception disorder in older adults is quite high. Not only because the brain is the targeted body of anesthesies and drugs used during surgery, but also because the elderly brain is very vulnerable to life expectancy.
1. What is mesmerizing?
Assication is the most common form in post-surgery elderly people, it is an urgent disorder and an erratic change in perception.
The basic features of the coma are:
- Changes in mental state include: pronounced disturbances in concentration and decreased awareness around.
- Occurs urgently and lasts for several hours to several days. The changes are very erratic at each stage of the day.
Occurs 10-15% in general surgery, over 30-50% in orthopedic and cardiac surgery. Coma needs to be monitored in particular and prolonged hospitalization, leading to increased treatment costs. In addition, coma also develops dementia and increases mortality within 1 year.
The mechanism of neurobiology is still unknown, one can only give factors that can lead to coma such as: hypoxia, drug interactions (especially anticholinergic substances, benzodiazebine, antidepressants), patients with alcoholism, having depression, dementia, or having some metabolism disorders.
The above factors do not speak of how surgery and anesthesia have affected on the coma. It is possible to explain the surgery that causes an inflammatory response and an acute inflammatory response that occurs both on the perthality and in the cerebral fluid so that coma usually occurs in more invasive surgeries than in small cases of procedures.
The role of anesthesia in causing coma is complex. Some drugs such as ketamin, benzodiazepine, propofol have caused assymol like anticholinergic drugs such as atropine, scopolamine. However, the rate of frostbite does not differ between anesthesia and spinal anesthesia or schial numbness, especially in cases where there is deep sedity in anesthesia, the risk of coma is higher.
4. Mesmerizing during the provincial period of coma
The patient acts in an ina <3>ular or improper action as required or the patient may be in a state of irritation. The form of coma during the provincial stage of coma can occur at any age but is most often noticed in children. The cause is unknown but fortunately it is often self-limiting and no special treatment is required except that the nurse has to pay more attention to the patient, needs good pain relief and can give sedatives.
Coma in the elderly does not occur during the period of provincial coma. The patient may be in an a stimulating state but is usually a less active envelope and occurs 24 or 72 hours after surgery, after fully conscious. This form of coma can be confused when it persists for a long time with another form of post-surgery cosy panic disorder that occurs more slowly. This form of post-surgery mesmerizing is similar to that of a coma in the ICU department and has been identified by Dr. Wes Ely and his partner as ICU
5. Risk of coma in elderly surgery
Over 70 years old, have a history of coma in the previous operation, alcoholism, preogmetic opiate use, pre-traumatic loss, heavy blood loss in surgery, large-volume blood transfusions, Hct after surgery below 30%, no good pain relief after surgery.
Those drugs that directly affect dosing are difficult to know for sure. Opting for spinal anesthesia or sural anesthesia or anesthesia has not found a difference in the frequency of frostbite.
The best way to prevent it is to avoid risk factors, avoid the use or minimal use of drugs that are prone to causing intosymetics. Signs of coma can also be an early sign of a severe body disease such as hypoxia, sepsis or pain.
Because the pathogenesa of coma and post-caesarean awareness disorders is still unclear, it is difficult to come up with a special measure to prevent or an appropriate treatment regimen. Therefore, there is no scientific basis that recommends a specific anesthetic or an insymable method suitable for an elderly patient.
After surgery, patients should be carefully examined and monitored by doctors and nurses for adjustments in the treatment regimen and handling of possible complications. Therefore, patients should perform surgery at reputable medical facilities to ensure that the process of anesthesia and anesthesia does not occur flaws.
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