RESUMEN
Objective To explore the relationship of perioperative INVOS cerebral oxygen saturation (rSO2) and postoperative cognition function alteration of geriatric patients under combined intravenous and volatile anesthesia with creatine phosphate disodium to provide guidance for clinical anesthesia. Methods Sixty ASA I-II patients aged >60 years scheduled for selective abdominal surgeries or surgeries on lower limb were enrolled in the study. The patients were randomly divided into 3 groups of 20 patients: creatine phosphate disodium group 1 (CPD1), creatine phosphate disodium group 2 (CPD2), control group (C). All the patients were not premedicated with atropine 0.5mg until entering the operation room. Anesthesia was induced with intravenous infusion of propofol, fentanyl and cisatracurium slowly, and maintained by inhalational anesthetics sevoflurane 1 MAC plus intravenous infusion of propofol (6-8mg·kg-1·min-1) and remifentanyl (0.2-0.4μg·kg-1·min-1), and intravenous bolus cisatracurium (0.07-0.10mg·kg-1). After tracheal intubation, all the patients were mechanically ventilated with PETCO2 in the normal range. rSO2 was continuously monitored and recorded during the operation. The Mini-Mental State Examination (MMSE), Trailmaking Test and Grooved Pegboard Test were used to access cognitive function 24h before surgery and 4, 8, 12, 24h after surgery. Results (1) There were no significant differences in general status between the three groups (P>0.05). (2) The scores of MMSE, Trail-making Test and Grooved Pegboard Test were not different 24h before the operation between the three groups (P>0.05). (3) The scores of cognitive tests were higher in group CPD2 and group CPD1 than in group C (P0.05). Conclusion CPD can reduce the occurrence of postoperative cognitive dysfunction in geriatric patients under combined intravenous and inhalational anesthesia.
RESUMEN
BACKGROUND: Near infrared spectroscopy (NIRS) to monitor regional cerebral oxygen saturation (rSO2) is a noninvasive and simple modal ity in clinical use. The ability of rSO2 as an index of cerebral oxygenation has been well demonstrated. However, the reliability of rSO2 to reflect the changes of cerebral vascular reactivity in the changes of arterial partial pressure of CO2 (PaCO2) has not been established. The aim of this study was to verify the reliability of rSO2 to measure the CO2 reactivity of cerebral vasculatures. METHODS: Twenty healthy adult patients undergoing general anesthesia were enrolled in this study. Anesthesia was induced with propofol and maintained with desflurane/N2O. Respiration was mechanically controlled. The radial artery and jugular bulb were cannulated. The sensor of the NIRS was attached to the ipsilateral forehead. During normocapnia (PaCO2 40 +/- 1.3 mmHg) and hypocapnia (PaCO2 30 +/- 2.4 mmHg), blood was obtained from the radial artery and jugular bulb and analyzed. rSO2 was compared with fSO2 (estimated field oxygen satuation), and the gold standard of tissue oxygen saturation. fSO2 was calculated from the following equation: fSO2 = 0.75 SjO2 + 0.25 SaO2. RESULTS: rSO2 significantly correlated with fSO2 (P = 0.000, r2 = 0.56). A bias of - 5.8% with a precision 12.94% was found. CONCLUSIONS: We concluded that rSO2 can be a reliable predictor to measure CO2 reactivity of cerebral vasculatures during normocapnia and hypocapnia.