The Effect of General Anesthesia on the Development of Postoperative Cognitive Dysfunction in Patients With Coronary Heart Disease After Off-Pump Coronary Artery Bypass Grafting

Introduction. The problem of cognitive dysfunction development as a direct complication of anesthetic support for cardiac surgery, as well as long-term cognitive changes that occur in the postoperative period, is becoming increasingly important due to the increasing frequency and volume of cardiac surgery. The incidence of postoperative cognitive dysfunction depends on the type of surgery and is more pronounced in patients who have undergone cardiac surgery. The etiology and pathogenesis of POCD is the subject of active research. One of the main theories is the neurotoxic effect of anesthetics on neural structures. Objective. Investigate the incidence of postoperative cognitive dysfunction in the early and delayed periods in patients with coronary heart disease who underwent off-pump coronary artery bypass grafting under general anesthesia based on sevoflurane and a combination of sevoflurane and dexmedetomidine. Materials and methods. The study was conducted based on Shalimov National Science Center of Surgery and Transplantology of National Academy of Medical Sciences of Ukraine in the period from 2022 to 2024. The study included 50 patients with coronary artery disease who underwent off-pump coronary artery bypass grafting. Results and Discussion. Our study revealed a high incidence of postoperative cognitive dysfunction (POCD) in patients with coronary heart disease who underwent off-pump coronary artery bypass grafting. POCD was observed in 45.8 % of patients undergoing sevoflurane anesthesia, while in the group where dexmedetomidine was additionally used, this figure was lower – 36.6 %. Over time, the incidence of POCD gradually decreased. In the dexmedetomidine group, its level almost returned to preoperative values (4.5 %), while in the sevoflurane group, 16.7 % of patients had persistent cognitive impairment. The use of dexmedetomidine reduced the need for fentanyl and rocuronium bromide during surgery. Conclusions. This clinical study demonstrated that the combination of sevoflurane and dexmedetomidine reduces the incidence of postoperative cognitive dysfunction (POCD) and reduces the need for analgesics and muscle relaxants during surgery in patients with coronary artery disease who underwent off-pump coronary artery bypass grafting.