The online version of this article (doi:10.1186/1471-2253-14-58) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
FS conceived the study, participated in its design and coordination, recruited and informed the patients, collected and interpreted data, and helped to draft the manuscript. MD and TB participated in design and data collection, analysis and interpretation. AB, MB, and IG recruited and informed the patients and participated in data collection. FT made substantial contributions to the statistical design, undertook the statistical analysis, interpreted the data, and helped to critically revise the manuscript. NF participated in the design and has been involved in drafting and revising the manuscript critically for important intellectual content; she has given final approval of the version to be published. All authors have read and approved the final manuscript.
Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function.
Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms.
We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).
Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.
Owen-Reece H, Smith M, Elwell CE, Goldstone JC: Near infrared spectroscopy. Br J Anaesth. 1999, 982: 418-426. CrossRef
Casati A, Spreafico E, Putzu M, Fanelli G: New technology for noninvasive brain monitoring: continuous cerebral oximetry. Minerva Anesthesiol. 2006, 72: 602-625.
Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, Fierro G, De Cosmo G, Servillo G, on behalf of the Collaborative Italian Study Group on Anesthesia in Elderly Patients: Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005, 101: 740-747. 10.1213/01.ane.0000166974.96219.cd. CrossRefPubMed
Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S, Danelli G, Nuzzi M, Mentegazzi F, Torri G, Martani C, Spreafico E, Fierro G, Pugliese F, De Cosmo G, Aceto P, Servillo G, Monaco F, on behalf of the Collaborative Italian Study Group on Anaesthesia in Elderly Patients: Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol. 2007, 24: 59-65. PubMed
Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, Rodriguez AL, Magovern CJ, Zaubler T, Freundlich K, Parr G: Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009, 87: 36-44. 10.1016/j.athoracsur.2008.08.070. CrossRefPubMed
Rey A: L’examen clinique en psychologie. 1964, Paris: Presses Universitaires de France
Wechsler D: Wechsler Memory Scale-Third Edition. 1997, San Antonio: The Psychological Corporation
Wechsler D: WAIS-III escala intellectual de Wechsler para adultos, manual técnico. 1999, Madrid: TEA Ediciones
Reitan R: Trail Making Test: Manual for Administration, Scoring, and Interpretation. 1956, Bloomington: Indiana University
Eysenck HJ, Eysenck SBG: Cuestionario revisado de la personalidad de Eysenck (EPQ-R). 1997, Madrid: TEA Ediciones
Rasmussen LS, O’Brien JT, Silverstein JH, Johnson TW, Siersma VD, Canet J, Jolles J, Hanning CD, Kuipers HM, Abildstrom H, Papaioannou A, Raeder J, Yli-Hankala A, Sneyd JR, Muñoz L, Moller JT, for the ISPOCD investigators: Is peri-operative cortisol secretion related to post-operative cognitive dysfunction?. Acta Anaesthesiol Scand. 2005, 49: 1225-1231. 10.1111/j.1399-6576.2005.00791.x. CrossRefPubMed
Johnson T, Monk T, Rasmussen LS, Abildstrom H, Houx P, Korttila K, Kuipers HM, Hanning CD, Siersma VD, Kristensen D, Canet J, Ibañaz MT, Moller JT, for the ISPOCD2 investigators: Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology. 2002, 96: 1351-1357. 10.1097/00000542-200206000-00014. CrossRefPubMed
Jayakar A, Dunoyer C, Rey G, Yaylali I, Jayakar P: Near-infrared spectroscopy to define cognitive frontal lobe functions. J Clin Neurophysiol. 2005, 22: 415-417. PubMed
Fudickar A, Peters S, Stapelfeldt C, Serocki G, Leiendecker J, Meybohm P, Steinfath M, Bein B: Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study. BMC Anesthesiol. 2011, 11: 1-6. 10.1186/1471-2253-11-1. CrossRef
- Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II