Effect of nimodipine on postoperative delirium in elderly patients with lacunar infarction / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of nimodipine on postoperative delirium (POD) in elderly patients with lacunar infarction. Methods Sixty patients with lacunar infarction of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, scheduled for elective spinal surgery under general anesthesia, were divided into 2 groups (n= 30 each) using a random number table control group (group C) and nimodipine group (group N). Nimodipine 7. 5 μg·kg-1 ·h-1 was in-travenously infused starting from 30 min before anesthesia induction until the end of surgery in group N, while the equal volume of normal saline was given in group C. At 30 min before infusing nimodipine (T1 ), immediately after tracheal intubation (T2 ), at 1 h after skin incision (T3 ) and at the end of surgery (T4 ), blood samples were taken from the radial artery and jugular bulb for blood gas analysis. Jugular bulb oxygen content, arterial-jugular bulb oxygen content difference, cerebral oxygen uptake rate and jugular-arterial lactate concentration difference were calculated. The concentrations of S100β protein and brain-derived neurotrophic factor (BDNF) in serum of the jugular bulb were measured by enzyme-linked immunosorbent as-say. The occurrence of POD was recorded within 3 days after operation. Results Compared with group C, jugular bulb oxygen content was significantly increased, and arterial-jugular bulb oxygen content difference and cerebral oxygen uptake rate were decreased at T3,4 , the concentrations of serum S100β protein were de-creased and the concentrations of brain-derived neurotrophic factor were increased at T2-4 , the incidence of POD was decreased (P<0. 05), and no significant change was found in jugular-arterial lactate concentra-tion difference at each time point in group N (P>0. 05). Conclusion Nimodipine can reduce the devel-opment of POD, and the mechanism may be related to improving intraoperative cerebral oxygen metabolism and reducing brain injury in elderly patients.