The perioperative application of continuous cerebral autoregulation monitoring for cerebral protection in elderly patients
| Autor: | Hong Zhang, Jian Tan, Xiao-Ying Zhang, Jiangbei Cao, Hao Li, Yunliang Zhang, Yitian Yang, Yanhong Liu, Peiyao Li, Qiang Fu, Weidong Mi |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Advanced and Specialized Nursing Mean arterial pressure Spectroscopy Near-Infrared business.industry medicine.medical_treatment Trendelenburg position Remifentanil Perioperative Cerebral oxygen saturation Middle Aged Cerebral autoregulation Sevoflurane Anesthesiology and Pain Medicine Cerebrovascular Circulation Anesthesia medicine Homeostasis Humans Arterial Pressure Oximetry business Propofol Aged medicine.drug |
| Zdroj: | Annals of Palliative Medicine. 10:4582-4592 |
| ISSN: | 2224-5839 2224-5820 |
| Popis: | BACKGROUND The majority of surgical patients aged 65 years and over are accompanied with underlying conditions, making them susceptible to perioperative cerebral complications. Here, we investigated the clinical value of continuous cerebral autoregulation (CA) monitoring in protecting against cerebral dysfunction in elderly patients undergoing surgery. METHODS This study enrolled 40 elderly patients (aged ≥65 years) and 40 middle-aged patients (aged 45 to 64 years) selected to undergo robotic-assisted laparoscopic radical prostatectomy. Cerebral oxygenation was assessed by regional cerebral oxygen saturation (rScO2) using near-infrared spectroscopy (NIRS). CA function was estimated using the cerebral oximetry index (COX), which is the rolling correlation between rScO2 and the mean arterial pressure (MAP). With the patient in the Trendelenburg position, the rScO2, MAP, calculated COX, HR, end-tidal CO2, and sevoflurane concentrations were continuously recorded. Standardized anesthesia was administered to all patients (sevoflurane, propofol, remifentanil, and rocuronium). Postoperative delirium (POD) was screened for daily using the Confusion Assessment Method (CAM). The primary outcome was the difference in periods of CA dysfunction between the elderly and middle-aged groups. Secondary outcomes included the incidence of POD and the optimal MAP range in the 2 groups. RESULTS Taking positive COX values (cutoff ≥0.3) to reflect periods of CA dysfunction, we found that the cumulative duration of CA dysfunction in the Trendelenburg position was longer in elderly patients than in middle-aged patients [ratio of cumulative time of CA dysfunction: middle-aged group, 32.8% (26.3%, 43.1%) vs. elderly group, 42.2% (33.1%, 51.2%)] (P |
| Databáze: | OpenAIRE |
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