الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
After approval of institutional ethical committee of faculty of medicine – Minia University (No. 164:01/2019) and written informed consent from all the participants, this prospective double blind randomized control study was registered in Clinical Trial Gov.( no.NCT04154449) and was conducted in the period from 25th February 2019 to February 2020 in Minia University Hospital and conducted on 63 middle aged participants of both sex, The participants included in this study were randomly allocated into three groups two surgical and one non-surgical age matched control group (21 patients each):
• group I: surgical patients received preoperative 160 IU intranasal regular insulin.
• group P: surgical patients received placebo (equal volume of 0.9 normal saline).
• group C: non- surgical age matched control group of the patients’ relatives.
This study aimed to determine the occurrence of postoperative cognitive dysfunction and evaluate the effect of administration of preoperative 160 IU intranasal regular insulin in middle aged patients undergoing major non cardiac surgery under general anesthesia.
Before inclusion into the study, the cognitive function all the subjects were evaluated through Mini-mental state to exclude any CNS disease and dementia. Those who verify the inclusion criteria were subsequently assessed by neuropsychiatric tests at three occasions one day before surgery (basal), then at 7days and 3monthes postoperatively.
The neuropsychiatric tests were in the form of: -
1- Visual verbal learning test.
2- Letter digit coding test.
3- Concept shifting test.
4- Stroop color test.
Also, subjective cognitive function was assessed 1 day preoperatively and 3 months postoperative by:-
1- Instrumental activity of daily living (IADL).
2- Subjective cognitive functioning questionnaire (SCQ).
The surgical patients were also recruited to other investigations as:
1- Random blood sugar
2- Plasma insulin level.
Which are measured preoperatively before insulin administration (basal) and 1hr after administration, then intraoperatively (2hrs after administration) and7days postoperatively. In addition to the routine intraoperative monitoring.
The results of the study revealed no significant difference between the studied groups as regard patients’ characteristics and operative data.
Administration of intranasal insulin had no effect on plasma insulin, random blood sugar or intraoperative hemodynamics or any side effects.
The three groups were comparable regarding neuropsychiatric tests preoperatively and after 3 months. However, there was significant reduction in cognitive function at 7 days postoperatively in the two surgical groups than the control, However this reduction was significantly lower in insulin group than placebo group.
In conclusion, general anesthesia can induce cognitive dysfunction in middle aged patients undergoing major non cardiac surgeries and the administration of 160 IU of intranasal insulin was safe and effective in improving the early postoperative cognitive dysfunction (POCD).