to develop cerebral desaturation because of the reduced physiologic reserve that accompanies aging. To evaluate whether monitoring cerebral oxygen saturation (rSO2) minimizes intraoperative cerebral desaturation, we prospectively monitored rSO2 in 122 elderly patients undergoing major abdominal surgery with general anesthesia. Patients were randomly allocated to an intervention group (the monitor was visible and rSO2 was maintained at 75% of preinduction values; n 56) or a control group (the monitor was blinded and anesthesia was managed routinely; n 66). Cerebral desaturation (rSO2 reduction 75% of baseline) was observed in 11 patients of the treatment group (20%) and 15 patients of the control group (23%) (P 0.82). Mean (95% confidence intervals) values of mean rSO2 were higher (66% [64%–68%]) and the area under the curve below 75% of baseline (AUCrSO2275% of baseline) was lower (0.4 min% [0.1– 0.8 min%]) in patients of the treatment group than in patients of the control group (61% [59%–63%] and 80 min% [2–144 min%], respectively; P 0.002 and P 0.017). When considering only patients developing intraoperative cerebral desaturation, a lower Mini Mental State Elimination (MMSE) score was observed at the seventh postoperative day in the control group (26 [25–30]) than in the treatment group (28 [26 –30]) (P 0.02), with a significant correlation between the AUCrSO2 75% of baseline and postoperative decrease in MMSE score from preoperative values (r20.25, P0.01). Patients of the control group with intraoperative cerebral desaturation also experienced a longer time to postanesthesia care unit (PACU) discharge (47 min [13–56 min]) and longer hospital stay (24 days [7–53] days) compared with patients of the treatment group (25 min [15–35 min] and 10 days [7–23 days], respectively; P 0.01 and P 0.007). Using rSO2 monitoring to manage anesthesia in elderly patients undergoing major abdominal surgery reduces the potential exposure of the brain to hypoxia; this might be associated with decreased effects on cognitive function and shorter PACU and hospital stay.

Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia / Casati, A; Fanelli, G; Pietropaoli, Paolo; Proietti, R; Tufano, R; Danelli, G; Fierro, Giovanni; DE COSMO, G; Servillo, G.. - In: ANESTHESIA AND ANALGESIA. - ISSN 0003-2999. - STAMPA. - 101:3(2005), pp. 740-747. [10.1213/01.ane.0000166974.96219.cd]

Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia

PIETROPAOLI, Paolo;FIERRO, Giovanni;
2005

Abstract

to develop cerebral desaturation because of the reduced physiologic reserve that accompanies aging. To evaluate whether monitoring cerebral oxygen saturation (rSO2) minimizes intraoperative cerebral desaturation, we prospectively monitored rSO2 in 122 elderly patients undergoing major abdominal surgery with general anesthesia. Patients were randomly allocated to an intervention group (the monitor was visible and rSO2 was maintained at 75% of preinduction values; n 56) or a control group (the monitor was blinded and anesthesia was managed routinely; n 66). Cerebral desaturation (rSO2 reduction 75% of baseline) was observed in 11 patients of the treatment group (20%) and 15 patients of the control group (23%) (P 0.82). Mean (95% confidence intervals) values of mean rSO2 were higher (66% [64%–68%]) and the area under the curve below 75% of baseline (AUCrSO2275% of baseline) was lower (0.4 min% [0.1– 0.8 min%]) in patients of the treatment group than in patients of the control group (61% [59%–63%] and 80 min% [2–144 min%], respectively; P 0.002 and P 0.017). When considering only patients developing intraoperative cerebral desaturation, a lower Mini Mental State Elimination (MMSE) score was observed at the seventh postoperative day in the control group (26 [25–30]) than in the treatment group (28 [26 –30]) (P 0.02), with a significant correlation between the AUCrSO2 75% of baseline and postoperative decrease in MMSE score from preoperative values (r20.25, P0.01). Patients of the control group with intraoperative cerebral desaturation also experienced a longer time to postanesthesia care unit (PACU) discharge (47 min [13–56 min]) and longer hospital stay (24 days [7–53] days) compared with patients of the treatment group (25 min [15–35 min] and 10 days [7–23 days], respectively; P 0.01 and P 0.007). Using rSO2 monitoring to manage anesthesia in elderly patients undergoing major abdominal surgery reduces the potential exposure of the brain to hypoxia; this might be associated with decreased effects on cognitive function and shorter PACU and hospital stay.
Abdomen; Aged; Analgesia, Patient-Controlled; Anesthesia Recovery Period; Anesthesia, General; Brain Chemistry; Double-Blind Method; Female; Hemodynamics; Humans; Hypoxia, Brain; Male; Monitoring, Intraoperative; Oximetry; Oxygen Consumption; Pain, Postoperative; Postoperative Complications; Prospective Studies; Anesthesiology and Pain Medicine
01 Pubblicazione su rivista::01a Articolo in rivista
Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia / Casati, A; Fanelli, G; Pietropaoli, Paolo; Proietti, R; Tufano, R; Danelli, G; Fierro, Giovanni; DE COSMO, G; Servillo, G.. - In: ANESTHESIA AND ANALGESIA. - ISSN 0003-2999. - STAMPA. - 101:3(2005), pp. 740-747. [10.1213/01.ane.0000166974.96219.cd]
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/38820
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 26
  • Scopus 275
  • ???jsp.display-item.citation.isi??? 240
social impact