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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction

Authors: Cheng Ni, Ting Xu, Nan Li, Yang Tian, Yongzheng Han, Qingsheng Xue, Min Li, Xiangyang Guo

Published in: BMC Anesthesiology | Issue 1/2015

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Abstract

Background

Postoperative cognitive dysfunction (POCD) is a frequent complication in elderly patients undergoing major non-cardiac surgery, but its etiology is still unclear. Cerebral oxygen saturation (ScO2) represents the balance of cerebral oxygen supply and demand. The aim of present study was to evaluate the relationship between perioperative ScO2 and POCD, and to verify the hypothesis that the value of ScO2 after multiple perioperative influential factors could predict POCD in elderly patients undergoing total knee arthroplasty (TKA).

Methods

Seventy eight Patients aged more than 65 years undergoing elective TKA with intrathecal anesthesia were enrolled. Cognitive functions were assessed one day before and 6 days after surgery, and POCD were defined according to ISPOCD. Demographics were recorded. Perioperative ScO2, blood pressure (BP), blood gas analysis and other clinical data were monitored and recorded, then the decrease of ScO2, BP and PaO2 after influential factors were calculated.

Results

POCD occurred in 15 patients (19.2 %). BP decreased after anesthesia induction and tourniquet deflation, and PaO2 decreased after cement implantation, then percentage decrease of BP was higher in POCD group. ScO2 of POCD group is significantly lower than non-POCD group (P < 0.05), and the absolute value and percentage decrease of ScO2 became significant between two groups after multiple influential factors. ScO2 after all influential factors (anesthesia induction, cement implantation and tourniquet deflation) had the best predictive performance for POCD (AUC = 0.742), and the optimal threshold was 66.5 %.

Conclusions

Perioperative ScO2 of patients with POCD is lower than patients without POCD. ScO2 after multiple perioperative influential factors could be an effective predictor for POCD, which reveal an important role of ScO2 decrease in the development of POCD and provide possible treatment target.
Literature
1.
Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93(4):947–53.PubMed
2.
Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective studydaggerdouble dagger. Eur J Cardiothorac Surg. 2015;47(3):447–54.PubMed
3.
Yoshitani K, Kuwajima K, Irie T, Inatomi Y, Miyazaki A, Iihara K, et al. Clinical validity of cerebral oxygen saturation measured by time-resolved spectroscopy during carotid endarterectomy. J Neurosurg Anesthesiol. 2013;25(3):248–53.PubMed
4.
Kishi K, Kawaguchi M, Yoshitani K, Nagahata T, Furuya H. Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers. J Neurosurg Anesthesiol. 2003;15(4):302–6.PubMed
5.
Teng Y, Ding H, Gong Q, Jia Z, Huang L. Monitoring cerebral oxygen saturation during cardiopulmonary bypass using near-infrared spectroscopy: the relationships with body temperature and perfusion rate. J Biomed Opt. 2006;11(2):024016.PubMed
6.
Faulkner JT, Hartley M, Tang A. Using cerebral oximetry to prevent adverse outcomes during cardiac surgery. Perfusion. 2011;26(2):79–81.PubMed
7.
Sun X, Ellis J, Corso PJ, Hill PC, Lowery R, Chen F, et al. Mortality predicted by preinduction cerebral oxygen saturation after cardiac operation. Ann Thorac Surg. 2014;98(1):91–6.PubMed
8.
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(5):E376–81.PubMed
9.
Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104(1):51–8.PubMed
10.
Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005;101(3):740–7. table of contents.PubMed
11.
Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857–61.PubMed
12.
Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18–30.PubMed
13.
Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18(5):552–8.PubMed
14.
Zheng F, Sheinberg R, Yee MS, Ono M, Zheng Y, Hogue CW. Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: a systematic review. Anesth Analg. 2013;116(3):663–76.PubMed
15.
Harris WH, Sledge CB. Total hip and total knee replacement (1). N Engl J Med. 1990;323(11):725–31.PubMed
16.
Papadopoulos G, Karanikolas M, Liarmakopoulou A, Papathanakos G, Korre M, Beris A. Cerebral oximetry and cognitive dysfunction in elderly patients undergoing surgery for hip fractures: a prospective observational study. Open Orthopaedics J. 2012;6:400–5.
17.
Lin R, Zhang F, Xue Q, Yu B. Accuracy of regional cerebral oxygen saturation in predicting postoperative cognitive dysfunction after total hip arthroplasty: regional cerebral oxygen saturation predicts POCD. J Arthroplasty. 2013;28(3):494–7.PubMed
18.
Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275–89.PubMed
19.
Salazar F, Donate M, Boget T, Bogdanovich A, Basora M, Torres F, et al. Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis. BMC Anesthesiol. 2014;14:58.PubMedPubMedCentral
20.
Deo H, West G, Butcher C, Lewis P. The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement. Knee. 2011;18(2):117–20.PubMed
21.
Rodriguez RA, Tellier A, Grabowski J, Fazekas A, Turek M, Miller D, et al. Cognitive dysfunction after total knee arthroplasty: effects of intraoperative cerebral embolization and postoperative complications. J Arthroplasty. 2005;20(6):763–71.PubMed
22.
Salazar F, Donate M, Boget T, Bogdanovich A, Basora M, Torres F, et al. Intraoperative warming and post-operative cognitive dysfunction after total knee replacement. Acta Anaesthesiol Scand. 2011;55(2):216–22.PubMed
23.
Ferrari M, Mottola L, Quaresima V. Principles, techniques, and limitations of near infrared spectroscopy. Can J Appl Physiol. 2004;29(4):463–87.PubMed
24.
Plachky J, Hofer S, Volkmann M, Martin E, Bardenheuer HJ, Weigand MA. Regional cerebral oxygen saturation is a sensitive marker of cerebral hypoperfusion during orthotopic liver transplantation. Anesth Analg. 2004;99(2):344–9. table of contents.PubMed
25.
Kamarainen A, Sainio M, Olkkola KT, Huhtala H, Tenhunen J, Hoppu S. Quality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest. Resuscitation. 2012;83(1):138–42.PubMed
26.
Ito N, Nanto S, Nagao K, Hatanaka T, Nishiyama K, Kai T. Regional cerebral oxygen saturation on hospital arrival is a potential novel predictor of neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest. Resuscitation. 2012;83(1):46–50.PubMed
27.
Edmonds Jr HL, Ganzel BL, Austin 3rd EH. Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth. 2004;8(2):147–66.PubMed
28.
Ono M, Brady K, Easley RB, Brown C, Kraut M, Gottesman RF, et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg. 2014;147(1):483–9.PubMed
29.
Godet G, Couaud A, Lucas A, Cardon A, Beloeil H, Ecoffey C. Cerebral oxygen saturation is improved by xenon anaesthesia during carotid clamping. HSR Proceedings in Intensive Care & Cardiovascular Anesthesia. 2013;5(2):110–8.
30.
Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103 Suppl 1:i3–13.PubMed
31.
Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000;93(4):964–70.PubMed
32.
Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch T, et al. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg. 2000;69(4):1162–6.PubMed
33.
Atallah MM, Hoeft A, El-Ghorouri MA, Hammouda GE, Saied MM. Does spinal anesthesia affect cerebral oxygenation during transurethral prostatectomy? Reg Anesth Pain Med. 1998;23(2):119–25.PubMed
34.
Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12–22.PubMed
35.
Sulek CA, Davies LK, Enneking FK, Gearen PA, Lobato EB. Cerebral microembolism diagnosed by transcranial Doppler during total knee arthroplasty: correlation with transesophageal echocardiography. Anesthesiology. 1999;91(3):672–6.PubMed
36.
Parmet JL, Horrow JC, Pharo G, Collins L, Berman AT, Rosenberg H. The incidence of venous emboli during extramedullary guided total knee arthroplasty. Anesth Analg. 1995;81(4):757–62.PubMed
37.
Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown 3rd JM, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87(1):36–44. discussion 44–35.PubMed
38.
Fudickar A, Peters S, Stapelfeldt C, Serocki G, Leiendecker J, Meybohm P, et al. Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study. BMC Anesthesiol. 2011;11:7.PubMedPubMedCentral
39.
Cho H, Nemoto EM, Yonas H, Balzer J, Sclabassi RJ. Cerebral monitoring by means of oximetry and somatosensory evoked potentials during carotid endarterectomy. J Neurosurg. 1998;89(4):533–8.PubMed
40.
Payne RS, Goldbart A, Gozal D, Schurr A. Effect of intermittent hypoxia on long-term potentiation in rat hippocampal slices. Brain Res. 2004;1029(2):195–9.PubMed
41.
Wong KK, Grunstein RR, Bartlett DJ, Gordon E. Brain function in obstructive sleep apnea: results from the Brain Resource International Database. J Integr Neurosci. 2006;5(1):111–21.PubMed
42.
Wang GL, Jiang BH, Rue EA, Semenza GL. Hypoxia-inducible factor 1 is a basic-helix-loop-helix-PAS heterodimer regulated by cellular O2 tension. Proc Natl Acad Sci U S A. 1995;92(12):5510–4.PubMedPubMedCentral
43.
Kaelin Jr WG, Ratcliffe PJ. Oxygen sensing by metazoans: the central role of the HIF hydroxylase pathway. Mol Cell. 2008;30(4):393–402.PubMed
44.
Powell FL, Kim BC, Johnson SR, Fu Z. Oxygen sensing in the brain--invited article. Adv Exp Med Biol. 2009;648:369–76.PubMed
45.
Ndubuizu OI, Chavez JC, LaManna JC. Increased prolyl 4-hydroxylase expression and differential regulation of hypoxia-inducible factors in the aged rat brain. Am J Physiol Regul Integr Comp Physiol. 2009;297(1):R158–65.PubMedPubMedCentral
46.
Bokeriia LA, Golukhova EZ, Breskina NY, Polunina AG, Davydov DM, Begachev AV, et al. Asymmetric cerebral embolic load and postoperative cognitive dysfunction in cardiac surgery. Cerebrovasc Dis. 2007;23(1):50–6.PubMed
47.
Shen X, Dong Y, Xu Z, Wang H, Miao C, Soriano SG, et al. Selective anesthesia-induced neuroinflammation in developing mouse brain and cognitive impairment. Anesthesiology. 2013;118(3):502–15.PubMedPubMedCentral
48.
Xie Z, Culley DJ, Dong Y, Zhang G, Zhang B, Moir RD, et al. The common inhalation anesthetic isoflurane induces caspase activation and increases amyloid beta-protein level in vivo. Ann Neurol. 2008;64(6):618–27.PubMedPubMedCentral
49.
Tao G, Zhang J, Zhang L, Dong Y, Yu B, Crosby G, et al. Sevoflurane induces tau phosphorylation and glycogen synthase kinase 3beta activation in young mice. Anesthesiology. 2014;121(3):510–27.PubMedPubMedCentral
Metadata
Title
Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction
Authors
Cheng Ni
Ting Xu
Nan Li
Yang Tian
Yongzheng Han
Qingsheng Xue
Min Li
Xiangyang Guo
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0117-6

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