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Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study

Published online by Cambridge University Press:  07 July 2006

A. Casati ,
G. Fanelli ,
P. Pietropaoli ,
R. Proietti ,
R. Tufano  and
S. Montanini
A. Casati
Affiliation:
Università degli Studi di Parma, Department of Anaesthesiology, Parma, Italy
G. Fanelli
Affiliation:
Università degli Studi di Parma, Department of Anaesthesiology, Parma, Italy
P. Pietropaoli
Affiliation:
Università degli Studi di Roma, Department of Anaesthesiology, Policlinico Umberto I, Italy
R. Proietti
Affiliation:
Università Cattolica di Roma, Department of Anaesthesiology, Policlinico Gemelli, Roma, Italy
R. Tufano
Affiliation:
Policlinico Universitario Federico II di Napoli, Department of Anaesthesiology, Napoli, Italy
S. Montanini
Affiliation:
Policlinico Universitario di Messina, Department of Anaesthesiology, Messina, Italy
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Extract

Summary

Background and objectives: The aim of this prospective, observational study was to evaluate changes in regional cerebral oxygen saturation (rSO2) and incidence of intraoperative cerebral desaturation in a cohort of elderly patients undergoing major abdominal surgery. Methods: rSO2 was continuously monitored on the left and right sides of the forehead in 60 patients older than 65 yr (35 males and 25 females; ASA II–III; age: 72 ± 5 yr; without pre-existing cerebral pathology, and baseline Mini Mental State Examination (MMSE) score >23) undergoing sevoflurane anaesthesia for major abdominal, non-vascular surgery >2 h. Results: Baseline rSO2 was 63 ± 8%; cerebral desaturation (rSO2 decrease <75% of baseline or <80% in case of baseline rSO2 <50%) occurred in 16 patients (26%). The MMSE decreased from 28 ± 1 before surgery to 27 ± 2 on 7th postoperative day (P = 0.05). A decline in cognitive function (decrease in MMSE score ≥ 2 points one week after surgery as compared to baseline value) was observed in six patients without intraoperative cerebral desaturation (13.6%) and six patients who had intraoperative cerebral desaturation (40%) (P = 0.057) (odds ratio: 4.22; CI95%: 1.1–16). Median (range) hospital stay was 14 (5–41) days in patients with an area under the curve of rSO2 <50% (AUCrSO2<50%) >10 min%, and 10 (4–30) days in those with an AUCrSO2<50% <10 min% (P = 0.0005). Conclusions: In a population of healthy elderly patients, undergoing non-vascular abdominal surgery cerebral desaturation can occur in up to one in every four patients, and the occurrence of cerebral desaturation is associated with a higher incidence of early postoperative cognitive decline and longer hospital stay.

Keywords

ANAESTHESIA GENERALAGEDCERBRAL ISCHAEMIAOXIMETRY, cerebralSURGERY ABDOMINALPOSTOPERATIVE PERIOD, cognitive function
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 1 , January 2007 , pp. 59 - 65
Copyright
© 2006 European Society of Anaesthesiology

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Footnotes

On behalf of the Collaborative Italian Study Group on Anaesthesia in Elderly Patients. All clinicians participants are co-authors (the list of names is included in the Appendix).

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