Top

Journal of Anesthesia

Published in:

01-06-2011 | Original Article

Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score

Authors: Koichi Suehiro, Ryu Okutai

Published in: Journal of Anesthesia | Issue 3/2011

Abstract

Purpose

Single-lung ventilation (SLV) is thought to reduce regional cerebral oxygen saturation (rSO₂). In this study, we evaluated changes in rSO₂ during SLV and their correlation with perioperative changes in cognitive function.

Methods

Sixty-nine patients participated in this study, each of whom received combined thoracic epidural and general anesthesia. rSO₂ was measured using INVOS 5100 (Somanetics, Troy, MI, USA) before anesthesia (baseline value) and until SLV was completed. Patient cognitive function was assessed using the mini mental state examination (MMSE) on the day before surgery (baseline) and then repeated 4 days after surgery. The patients were classified into two groups: with (desaturation group, group D) and without (nondesaturation group, group N) cerebral desaturation during SLV. Cerebral desaturation was defined as a reduction of rSO₂ during SLV less than 80% of the baseline value. An intergroup comparison was made between perioperative cognitive function findings (MMSE score change between baseline and 4th day after surgery). We also examined the correlation between the duration of desaturation during SLV and perioperative MMSE score changes in group D patients.

Results

Seventeen patients were included in group D. The MMSE score decrease was significantly higher in group D as compared to that in group N (P < 0.05). The duration of desaturation time was significantly negatively correlated with MMSE score change (r ² = 0.444, P < 0.05).

Conclusion

Duration of cerebral desaturation time during SLV correlates with MMSE score. Additional studies are needed to determine whether intervention against cerebral desaturation during SLV can prevent postoperative cognitive dysfunction.

Brodsky JB. Approaches to hypoxemia during single-lung ventilation. Curr Opin Anaesthesiol. 2001;14:71–6.PubMedCrossRef

Jobis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198:1264–7.CrossRef

Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anesth. 2005;52:79–87.PubMedCrossRef

Kussman BD, Wypij D, DiNardo JA, Newburger J, Jonas RA, Bartlett J, McGrath E, Laussen PC. An evaluation of bilateral monitoring of cerebral monitoring of cerebral oxygen saturation during pediatric cardiac surgery. Anesth Analg. 2005;101:1294–300.PubMedCrossRef

Murkin JM. Perioperative detection of brain oxygenation and clinical outcomes in cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8:13–4.PubMedCrossRef

Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum. 2004;7:376–81.CrossRef

Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, Fierro G, Cosmo GD, Servillo G. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005;101:740–7.PubMedCrossRef

Green DW. A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery. Eur J Anaesthesiol. 2007;24:230–4.PubMedCrossRef

Olsson C, Thelin S. Regional cerebral saturation monitoring with perfusion: diagnostic performance and relationship to postoperative stroke. J Thorac Cardiovasc Surg. 2006;131:371–9.PubMedCrossRef

10.

Ogasawara K, Konno H, Yukawa H, Endo H, Inoue T, Ogawa A. Transcranial regional cerebral oxygen saturation monitoring during carotid endarterectomy as a predictor of postoperative hyperperfusion. Neurosurgery. 2003;53:309–14.PubMedCrossRef

11.

Rigamonti A, Scandroglio M, Minicucci F, Magrin S, Carozzo A, Casati A. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy. J Clin Anesth. 2005;17:426–30.PubMedCrossRef

12.

Mille T, Tachimiri ME, Klersy C, Ticozzelli G, Bellinzona G, Blangetti I, Pirrelli S, Lovotti M, Odero A. Near infrared spectroscopy monitoring during carotid endarterectomy: which threshold value is critical? Eur J Vasc Endovasc Surg. 2004;27:646–50.PubMedCrossRef

13.

Dujovny M, Slavin KV, Hernandez G, Geremia GK, Ausman JL. Use of cerebral oximetry to monitor brain oxygenation reserves for skull base surgery. Skull Base Surg. 1994;4:117–21.PubMedCrossRef

14.

Edmonds HL Jr. Multi-modality neurophysiologic monitoring for cardiac surgery. Heart Surg Forum. 2002;5:225–8.PubMed

15.

Hemmerling TM, Bluteau MC, Kazan R, Braco D. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth. 2008;101:870–5.PubMedCrossRef

16.

Tonner PH, Kampen J, Scholz J. Pathophysiological changes in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17:163–77.PubMedCrossRef

17.

Liu LL, Wiener-Kronish JP. Perioperative anesthesia issues in the elderly. Crit Care Clin. 2003;19:641–56.PubMedCrossRef

18.

Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology. 2007;106:572–90.PubMedCrossRef

19.

Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Bielder A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD 1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857–61.PubMedCrossRef

20.

Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402.PubMedCrossRef

21.

Paquet C, Deschamps A, Denault AY, Couture P, Carrier M, Babin D, Levesque S, Piquette D, Lambert J, Tardif JC. Baseline regional cerebral oxygen saturation correlates with left ventricular systolic and diastolic function. J Cardiothorac Vasc Anesth. 2008;22:840–6.PubMedCrossRef

22.

Tonz M, Bachmann D, Mettler D, Kaiser G. Effects of one-lung ventilation on pulmonary hemodynamics and gas exchange in the newborn. Eur J Pediatr Surg. 1997;7:212–5.PubMedCrossRef

23.

Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, Rodriguez AL, Magovern CL, Zaubler T, Freundlich K, Parr GVS. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87:36–45.PubMedCrossRef

24.

Hong SW, Shim JK, Choi YS, Kim DH, Chang BC, Kwak YL. Prediction of cognitive dysfunction and patients outcome following valvular heart surgery and the role of cerebral oximetry. Eur J Cardiothorac Surg. 2008;33:560–5.PubMedCrossRef

25.

Sauer AM, Kalkman C, Dijk DV. Postoperative cognitive decline. J Anesth. 2009;23:256–9.PubMedCrossRef

26.

Folstein M, Folstein S, McHygh P. “MMSE”. A practical method for grading the cognitive state of patients for clinician. J Psychiatry Res. 1975;12:189–99.CrossRef

27.

Mondimore FM, Damlouji N, Folstein MF, Tune L. Post-ECT confusional states associated with elevated serum anticholinergic levels. Am J Psychiatry. 1983;140:930–1.PubMed

Title: Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score
Authors: Koichi Suehiro
Ryu Okutai
Publication date: 01-06-2011
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 3/2011
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-011-1136-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2011

Sevoflurane inhibits angiotensin II-induced Rho kinase-mediated contraction of vascular smooth muscle from spontaneously hypertensive rat

Postoperative respiratory failure caused by acute exacerbation of idiopathic interstitial pneumonia

Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency

Antiemetic prophylaxis in thyroid surgery: a randomized, double-blind comparison of three 5-HT3 agents

Use of a laryngeal mask airway to stop a supraglottic air leak which prevented adequate ventilation via a tracheostomy in a patient with cerebral palsy and pneumonia

Reversible cerebral vasoconstriction syndrome with limb myoclonus following intravenous administration of methylergometrine