Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis

Abstract

Background: Postoperative cognitive dysfunction (POCD) is common after surgery and anesthesia, particularly in older patients. It has been reported that regional cerebral oxygen saturation (rSO2) monitoring potentially influences the occurrence of POCD. However, its role in the prevention of POCD remains controversial in older patients. Additionally, the quality of evidence on this topic is still relatively poor. Methods: The electronic databases PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched using the indicated keywords from their inception to June 10, 2022. We limited our meta-analysis to randomized controlled trials (RCTs) that assessed the effects of rSO2 monitoring on POCD in older patients. Methodological quality and risk of bias were assessed. The primary outcome was the incidence of POCD during hospitalization. The secondary outcomes were postoperative complications and the length of hospital stay (LOS). Odds ratios (OR) and 95% confidence intervals (CI) were calculated to determine the incidence of POCD and postoperative complications. The standardized mean difference (SMD) instead of the raw mean difference and 95% CI were calculated for LOS. Results: Six RCTs, involving 377 older patients, were included in this meta-analysis. The incidence of POCD ranges from 17 to 89%, with an overall prevalence of 47% in our pooled analysis. Our results demonstrated that rSO2-guided intervention could reduce the incidence of POCD in older patients undergoing non-cardiac surgery (OR, 0.44; 95% CI, 0.25 to 0.79; P = 0.006) rather than cardiac surgery (OR, 0.69; 95% CI, 0.32 to 1.52; P = 0.36). Intraoperative rSO2 monitoring was also associated with a significantly shorter LOS in older patients undergoing non-cardiac surgery (SMD, -0.93; 95% CI, -1.75 to -0.11; P = 0.03). Neither the incidence of postoperative cardiovascular (OR, 1.12; 95% CI, 0.40 to 3.17; P = 0.83) nor surgical (OR, 0.78; 95% CI, 0.35 to 1.75; P = 0.54) complications were affected by the use of rSO2 monitoring. Conclusion: The use of rSO2 monitoring is associated with a lower risk of POCD and a shorter LOS in older patients undergoing non-cardiac surgery. This may have the potential to prevent POCD in high-risk populations. Further large RCTs are still warranted to support these preliminary findings.

Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery

“…The neurological deficits associated with IJVV incompetence are thought to be caused by cerebral hypoperfusion resulting from increased ICP by brain venous congestion. Cerebrovascular autoregulation plays a significant role in maintaining the stability of blood flow and cerebral perfusion pressure ( 17 , 18 ), but if it is disturbed, arterial hypertension may induce cerebral hyperemia and brain edema, while low arterial blood pressure can lead to cerebral ischemia.…”

The Role of Cerebral Oximetry in Predicting and Preventing Postoperative Cognitive Dysfunction

“…The use of rScO2 monitoring has been found to be associated with a lower risk of POCD and a shorter length of hospital stay in older patients undergoing noncardiac surgery. It has been suggested that rScO2 monitoring in high-risk populations may have the potential to prevent POCD 23 . In the past, evidence on whether interventions for cerebral oxygen desaturations reduce the risk of neurological outcomes has been limited to case reports and observational studies.…”

The pathogenesis of cognitive decline after cardiac surgery: A Narrative Review

“…blisko infracrvena spektroskopija), uređaja koji se koristi za monitoring regionalne cerebralne saturacije, te provođenje intervencijskih algoritama u slučaju cerebralne desaturacije, značajno snižava stupanj, tra janje i učestalost intraoperacijskih cerebralnih desatu racija, kao i nastanak novih lezija mozga utvrđenih MRom, ali bez jasnog dokaza o smanjenu učestalosti POKPa. [38][39][40] S obzirom kako je uporaba KPBa povezana s rizi kom nastanka ishemijskoreperfuzijske ozljede, ugro ženi bolesnici se u kliničkoj praksi intraoperacijski učestalo izlažu visokim koncentracijama kisika kako bi se izbjegla hipoksija mozga i miokarda. U zadnje vrijeme navodi se mogućnost kako je primjena hipe roksije škodljiva za bolesnika zbog pogoršanja ishe mijskoreperfuzijske ozljede i izazivanja izravne ozlje de tkiva reaktivnim spojevima kisika.…”