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

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

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 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.

Figures

Fig. 1
Fig. 1
ScO2 during anesthesia of non-POCD and POCD groups. ScO2 decreased during anesthesia, and ScO2 of POCD group was significantly lower than non-POCD group (P < 0.05). T1-6: before induction, 10 min and 20 min after anesthesia induction, 10 min and 20 min after cement implantation, and 10 min after tourniquet deflation
Fig. 2
Fig. 2
Percentage decreases of ScO2 in non-POCD and POCD groups after anesthesia induction, cement implantation and tourniquet deflation. *P < 0.05, **P < 0.01 in comparison with non-POCD group
Fig. 3
Fig. 3
Receiver-operator characteristic (ROC) curve for average ScO2 after tourniquet deflation to predict the occurrence of POCD. The area under ROC curve is 0.742, which is significantly different from random chance (P < 0.01). The optimal threshold for POCD detection is 66.5 %, with sensitivity and specificity are 73.3 and 58.7 % respectively

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