Early cognitive dysfunction after thoracic surgery with SLV is positively related to intraoperative decline of S(ct)O(2).

The closed-loop system was better at maintaining BIS and Analgoscore than manual administration.

M onitoring cerebral oxygen (O 2 ) saturation is increasingly important because studies in cardiac surgery have found that treating cerebral O 2 desaturations can reduce the likelihood of postoperative cognitive dysfunction (POCD) and other complications. Recent studies have shown that the incidence of cerebral O 2 desaturations in patients undergoing thoracic surgery with single-lung ventilation (SLV) is similar to that seen in cardiac surgery, with the risk of poor postoperative outcomes. This prospective, observational, single-blinded study was undertaken to determine POCD after thoracic surgery with SLV.The 76 patients were having elective thoracic surgery with SLV of an anticipated duration of more than 45 minutes. Monitoring included standard clinical parameters and absolute oximetry (S ct O 2 ). Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane to a target bispectral index of 45. A continuous infusion of bupivacaine and fentanyl was administered throughout the case via an epidural catheter. Brain O 2 saturation was monitored continuously using the FORE-SIGHT cerebral oximeter (CAS Medical Systems, Branford, Conn), starting before induction of anesthesia and continuing until extubation. Sensors were positioned bilaterally on the patient's forehead and covered to prevent ambient light from affecting the measurements. Values of the cerebral oximetry were hidden, and no anesthetic decision was made based on the absolute S ct O 2 values. Baseline S ct O 2 values were obtained in the awake patient after 2 minutes of breathing 100% O 2 through a face mask and defined as the average saturation value during a period of 1 minute, obtained 5 minutes after the application of the sensors. The average left and right absolute S ct O 2 values were collected every 5 minutes. Standard monitoring variables were recorded every 5 minutes. Arterial blood gas analysis was performed every 15 minutes. The average left and right absolute S ct O 2 and the highest and lowest values were used for analysis. The Mini-Mental State Exam (MMSE) test was used to assess cognitive function before surgery and at 3 and 24 hours postoperatively. Data were analyzed using SPSS (v.15.0; SPSS Inc, Chicago, Ill). The Spearman correlation test was used to test the correlation between POCD (defined as a decrease in MMSE score 92 points from baseline) and age, SLV duration, and selected clinical and S ct O 2 parameters.One patient was excluded from analysis because of unwillingness to redo the MMSE test after surgery. Most of the patients were American Society of Anesthesiologists physical status II and III. Duration of surgery was 175 minutes, and duration of SLV was 135 minutes. No patients needed additional continuous positive airway pressure or O 2 insufflations, and no surgical-site infections, postoperative hemorrhage, or stump leakage was observed. The baseline S ct O 2 value was 79% in the awake state, which decreased to a minimum value of 63% during SLV. This is equivalent to a decrease of S ct O 2 b...

We present the first human testing of a robotic intubation system for oral tracheal intubation. The success rate was high at 91%. Future studies are needed to assess the performance and safety of such a system.