Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery: a prospective cohort study

Abstract

Background Delirium is an acute mental disorder and common postoperative complication. Monitoring regional cerebral oxygen saturation (rSO 2 ) in endovascular therapeutic surgery may allow real-time monitoring of cerebral desaturation, avoiding profound cerebral dysfunction, and reducing the incidence of delirium. We sought to examine the incidence of delirium in patients undergoing endovascular surgery. Methods This was a clinical cohort trial (registered with http://www.clinicaltrials.gov [NCT02356133]). We monitored the rSO 2 of 43 patients undergoing general anesthesia and cerebral endovascular surgery. The occurrence of delirium after surgery was recorded with the Confusion Assessment Method (CAM). Multivariate logistic regression was performed to identify the main predictor of delirium. Results rSO 2 was significantly different between the delirium and no-delirium groups. The occurrence of delirium was 35% in our cohort, and higher rSO 2 desaturation scores were significantly associated with profound delirium (higher CAM score; odds ratio = 1.002; P = 0.021). The maximum declines of systolic blood pressure were 24.86 (21.78–27.93) and 32.98 (28.78–37.19) in the no-delirium and delirium groups, respectively, which were significantly different ( P = 0.002) but not closely associated with delirium in multivariate analysis ( P = 0.512). Anesthesia, mechanical ventilation duration, and having two vascular risk factors differed significantly between groups but were poorly associated with delirium outcome. Conclusions Elevated rSO 2 desaturation score was predictive of the occurrence of postoperative delirium following endovascular surgery. Monitoring rSO 2 is invaluable for managing controlled hypotension during endovascular surgery and reducing postoperative delirium. Trial registration ClinicalTrials.gov, NCT02356133 . Registered 1 February 2015. All statistical analysis results submitted August 4, 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3586-y) contains supplementary material, which is available to authorized users.

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

“…Continuous monitoring of rSO 2 using the NIRS can reflect the oxygen supply, oxygen consumption, and cerebral perfusion on time (16). Studies have shown that decreased intraoperative rSO 2 is significantly associated with postoperative neurological dysfunction (17)(18)(19). A prospective cohort study including 43 patients undergoing cerebral endovascular surgery showed that the decrease of rSO 2 can be used to predict delirium and that the continuous monitoring of rSO 2 can reduce the incidence of postoperative delirium (19).…”

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

“…For example, Wang X. [ 53 ] evaluated patients once a day, Maheshwari [ 52 ] twice a day, while Neerland [ 33 ] did not perform POD assessment on weekend days, and Soh [ 48 ] observed patients only up to 48 h after surgery. It must be remembered that current guidelines recommend that evaluation should be performed every 8 h or at least once per nurse shift throughout the hospitalization [ 66 ].…”

“…Patti et al [ 42 ] the recognized IOH also in the case of long-term intraoperative use of catecholamines. In the remaining 7 studies the lowest intraoperative MAP, SBP or DBP [ 33 , 45 , 47 , 53 , 54 ] values were assessed or different strategies of intraoperative BP management were evaluated [ 39 ]. Furthermore, the authors applied various methods of BP monitoring: invasive and non-invasive, and additionally, used different time intervals for measurements, ranging between 1 and 15 min, which means that shorter episodes of hypotension could have been missed.…”

“…In a small study covering 39 patients (median age 52 years, IQR 47–57) undergoing elective endovascular intracranial aneurysm treatment [ 53 ], the maximal intraoperative decrease of systolic BP was significantly higher in those who developed POD (33 mmHg vs. 25 mmHg, p = 0.002), but this effect was not confirmed in multivariate analysis ( p = 0.5). POD was diagnosed in 35% of patients by using the CAM algorithm.…”

Intraoperative Oxygen Concentration and Postoperative Delirium After Laparoscopic Gastric and Colorectal Malignancies Surgery: A Randomized, Double-Blind, Controlled Trial

“… 10 The rSO 2 value is a very sensitive indicator of cerebral hypoxia, which can cause cerebral hypoperfusion, resulting in POD. 11 , 12 At present, there is no unified standards for the optimal FiO 2 in operation, which is 30% ~ 100% in clinical operation. However, for elderly patients undergoing laparoscopic abdominal surgery, no unified conclusion has been reached on the effects of different FiO 2 on POD.…”