The use of hopantenic acid for the correction of postoperative cognitive dysfunction in school-age children: A randomized trial.

Abstract

INTRODUCTION. To date, there is no doubt that anesthetics are neurotoxic to developing brain and may cause postoperative cognitive dysfunction (POCD). Therefore, research on the prevention and treatment of cognitive disorders in children, are relevant. Hopantenic acid-is a nootropic agent, has a stimulating effect on the CNS against a background of cerebral insufficiency of exogenous origin in children. OBJECTIVES. Assessment of the feasibility and efficacy of Hopantenic acid for the correction of early postoperative cognitive dysfunction in school-age children. METHODS. In accordance with inclusion and exclusion criteria, we examined 40 children of school age (7-16 years old, physical status ASAI-ASAII) with routine surgical pathology (varicocele, cryptorchidism, inguinal hernia). All children received standard total intravenous anesthesia (TIVA): propofol 6-7.5 mg/kg x h and phentanyl 2.5-3 mkg/kg x h. Monitoring: harward standard and bispectral index (BIS). The same level of anesthesia depth was maintained intraoperatively in all cases: values of BIS = 40-60 %. Duration of TIVA-50-80 min (68.2 + 12.5). Before and after surgery (first day, at discharge, one month) in all children neuropsychological status including Bourdon test, test "10 words", Spielberger scale and Conners Rating scale was assessed. After surgery patients were randomized (Seed # 18,494. www.randomization.com) in two groups: A (n = 20 control); B (n = 20 for cerebral protection Hopantenic acid (Pantogam) 40 mg/kg 9 day was given per os in one month after surgery). Statistical significance was determined using Wilcockson-Mann-Whitney's criterion (U). Quantitative data are expressed with median and standard deviation, and qualitative data-with percentage. RESULTS. Two groups were comparable for the main confounding factors (by age, sex, anthropometric data, duration of anesthesia, hemodynamic profile, doses of drugs and the depth of anesthesia). It was found that using TIVA (on the basis of propofol and fentanyl), in the early postoperative period 62.5 % of school-age children has evolved POCD, which persisted in the group A at discharge and 1 month after the surgery in 80 % of cases. Cerebral protection with Hopantenic acid significantly decreased severity of POCD or totally ceased its symptoms by the time of discharge (3-5 days in low-traumatic operations). The cty short-term memory in the stages of the s Conners rating scale through a month after surgery showed a decrease in the Group B level of hyperactivity and inattention compared with controls (16.7 + 8.3 vs. 26.2 + 7.2; p = 0.003). Through 1 month after surgery in 30 % of patients in group B an improvement cognitive function compared with preoperative data was observed. CONCLUSIONS. Hopantenic acid (40 mg/kg per day) is effective in the treatment and prevention of POCD in school-aged children operated under TIVA, based on propofol and fentanyl.F.