Postoperative cognitive dysfunction after robot-assisted radical cystectomy (RARC) with cerebral oxygen monitoring an observational prospective cohort pilot study

Yue Li, Dan Huang, Diansan Su, Jie Chen, Liqun Yang, Yue Li, Dan Huang, Diansan Su, Jie Chen, Liqun Yang

Abstract

Background: The incidence and risk factors of postoperative cognitive dysfunction (POCD) during robot-assisted radical cystectomy (RARC) in extreme Trendelenburg positioning and pneumoperitoneum are still controversial. The aim of this prospective observational study was to find the incidence rate as well as possible risk factors of POCD in RARC with cerebral oxygen monitoring.

Methods: Patients who underwent RARC and open abdominal surgery in horizontal positioning were included. Preoperative and postoperative arterial blood gas (ABG), S-100β, C-reactive protein (CRP), and cognitive dysfunction scales were tested. Also, we used Z score to analyze and comprehensively evaluate POCD. Measurements of heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), end-tidal CO2 (etCO2), and cerebral oxygen were immediately obtained after different time points during the surgery.

Results: Here, 24 and 23 patients were included in the RARC group and in the control group, respectively. The incidence of POCD didn't have significant difference in RARC group (45.8%), in contrast to the control group (26.1%). The laboratory tests of s100β and CRP between two groups didn't contain significant difference as well. As duration of Trendelenburg and pneumoperitoneum prolonged, the cerebral oxygen saturation in the RARC group increased, which didn't cause excessive perfusion nevertheless (rSO2<75%). We compared laboratory tests, age, education status, blood loss, and fluid input between POCD and non-POCD patients. A significant difference was found in the serum concentrations of CRP (72.59 ± 42.09 vs. 48.50 ± 26.53, P = 0.025) and age (69.20 ± 7.033 vs. 65.34 ± 5.228, P = 0.041).

Conclusion: RARC in extreme Trendelenburg positioning and pneumoperitoneum did not significantly increase the incidence of POCD and didn't cause excessive perfusion. The inflammation marker CRP and age might be independent risk factors of POCD.

Trial registration: Clinicaltrials.gov with registration number NCT03372135 . Registered 1 November 2017 (retrospectively registered).

Keywords: Cerebral oxygen saturation; Postoperative cognitive dysfunction; Robot-assisted radical cystectomy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The cerebral oxygen saturation in RARC group at different time points. (T0 = Baseline; T1 = anesthesia induction; T2 = Trendelenburg position and pneumoperitoneum; T3 = 1 h after Trendelenburg position and pneumoperitoneum; T4 = 2 h after Trendelenburg position and pneumoperitoneum; T5 = 3 h after Trendelenburg position and pneumoperitoneum; T6 = repositioning; T7 = end of procedure)
Fig. 2
Fig. 2
The cerebral oxygen saturation in RARC group and the control group. rSO2 values increased as duration of Trendelenburg position and pneumoperitoneum prolonged in the RARC group

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