Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.10.003
Brazilian Journal of Anesthesiology
Scientific Article

Impact of hypotension and global hypoperfusion in postoperative delirium: a pilot study in older adults undergoing open colon surgery

Impacto da hipotensão e hipoperfusão global sobre o delírio pós-operatório: um estudo piloto com idosos submetidos à cirurgia aberta do cólon

Eduardo Tobar; Mario A. Abedrapo; Jaime A. Godoy; Jose L. Llanos; Mauricio J. Díaz; Rodrigo Azolas; Gunther R. Bocic; Jaime A. Escobar; Rodrigo A. Cornejo; Carlos M. Romero

http://dx.doi.org/10.1016/j.bjane.2017.10.003 Braz J Anesthesiol, vol.68, n2, p.135-141, 2018
PDF English
PDF Português
Downloads: 0
Views: 928

Abstract

Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.

Keywords

Delirium, Hypotension, Global perfusion, Central venous oxygen saturation, Lactate, Cerebral oxygenation

Resumo

Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.

Palavras-chave

Delírio, Hipotensão, Perfusão global, Saturação venosa central de oxigênio, Lactato, Oxigenação cerebral

References

Gleason LJ, Schmitt EM, Kosar CM. Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA Surg. 2015;150:1134-40.

Bilotta F, Lauretta MP, Borozdina A. Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013;79:1066-76.

Raats JW, van Eijsden WA, Crolla RM. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLOS ONE. 2015;10:e0136071.

Inouye SK, Marcantonio ER, Kosar CM. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients. Alzheimers Dement. 2016;12:766-75.

Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220:136.e1-48.e1.

Scholz AF, Oldroyd C, McCarthy K. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. Br J Surg. 2016;103:e21-8.

Marcantonio ER, Goldman L, Orav EJ. The association of intraoperative factors with the development of postoperative delirium. Am J Med. 1998;105:380-4.

Wesselink EM, Kappen TH, van Klei WA. Intraoperative hypotension and delirium after on-pump cardiac surgery. Br J Anaesth. 2015;115:427-33.

Hirsch J, DePalma G, Tsai TT. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth. 2015;115:418-26.

Konar A, Singh P, Thakur MK. Age-associated cognitive decline: insights into molecular switches and recovery avenues. Aging Dis. 2016;7:121-9.

Burkhart CS, Rossi A, Dell-Kuster S. Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation. Br J Anaesth. 2011;107:742-8.

Quiroga P, Albala C, Klaasen G. Validation of a screening test for age associated cognitive impairment, in Chile. Rev Med Chil. 2004;132:467-78.

Schoen J, Meyerrose J, Paarmann H. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care. 2011;15:R218.

Mangnall LT, Gallagher R, Stein-Parbury J. Postoperative delirium after colorectal surgery in older patients. Am J Crit Care. 2011;20:45-55.

Pearse R, Dawson D, Fawcett J. Changes in central venous saturation after major surgery, and association with outcome. Crit Care. 2005;9:R694-9.

Multicentre study on peri- and postoperative central venous oxygen saturation in high-risk surgical patients. Crit Care. 2006;10:R158.

Donati A, Loggi S, Preiser JC. Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest. 2007;132:1817-24.

Grocott MP, Dushianthan A, Hamilton MA. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth. 2013;111:535-48.

Aktuerk D, Mishra PK, Luckraz H. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: observational case series. Ann Card Anaesth. 2016;19:59-62.

Kara I, Erkin A, Sacli H. The effects of near-infrared spectroscopy on the neurocognitive functions in the patients undergoing coronary artery bypass grafting with asymptomatic carotid artery disease: a randomized prospective study. Ann Thorac Cardiovasc Surg. 2015;21:544-50.

Nadelson MR, Sanders RD, Avidan MS. Perioperative cognitive trajectory in adults. Br J Anaesth. 2014;112:440-51.

Dokkedal U, Hansen TG, Rasmussen LS. Cognitive functioning after surgery in middle-aged and elderly Danish twins. Anesthesiology. 2016;124:312-21.

Radtke FM, Franck M, Lendner J. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110(^sSuppl. 1):i98-i105.

Chan MT, Cheng BC, Lee TM. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33-42.

5dcc4a900e8825345fbf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections