Overview
The primary objective of the study is to describe the value of interhemispheric asymmetry (ASYM), during the different intra- and peri-operative phases, in those patients who develop or do not develop post-operative delirium (POD) during the first 30 post-operative days and postoperative cognitive disfunction (POCD) in the first 90 post-operative days, in a population undergoing head&neck and plastic surgery with a priori increased probability of POD.
Description
Values of the study variables will be extract in these specific moments (considering a delay of thirty seconds between the in vivo phenomenon and the instrument): (t1) BIS probe application (t2) 60" before GA administration (t3) 60" after myoresolution (t4) intubation (t5) surgical incision (t6) end of ipnosis (t7) 10 minutes after extubation. Daily follow-up for the first five post-operative days is performed in order to verify the onset of POD and a telephone follow-up at thirty and ninety post-operative days in order to verify the onset of POD / POCD.
CAM scale will be used for the diagnosis of POD; while for the diagnosis of POCD, 6-CIT test will be used, the EQ50 test in the case of tracheostomized patients.
Eligibility
Inclusion Criteria:
-Patients, undergoing head&neck surgery, who have at least 3 of the following criteria (to establish "a priori" increased risk of POD):
- Age> 70;
- Male sex; or ASA III;
- Smoker;
- High blood pressure;
Exclusion Criteria:
- ASA IV, V or ASA IE, IIE, IIIE (patients with anesthetic risk ASA>III and those undergoing urgent-emergency surgery will be excluded from the study);
- Past positive medical history for:
- Stroke;
- Dementia;
- Cerebral aneurysm;
- Intracranial mass;
- Head trauma;
- Epilepsy;
- Diabetes mellitus;
- Previous neurosurgical intervention;
- Psychiatric illnesses requiring chronic treatment;
- Patients undergoing surgery in the previous two weeks;
- Patients whose hospitalization duration is estimated to be less than five days;
- Lack of understanding of the Italian language or English;
- Age <18 years.