Aim:This study was conducted to examine perioperative cerebral oximetry changes in elderly patients undergoing hip fracture repair and evaluate the correlation between regional oxygen saturation (rSO2) values, postoperative cognitive dysfunction (POCD) and hospital stay.Materials and Methods:This prospective observational study included 69 patients. Data recorded included demographic information, rSO2 values from baseline until the second postoperative hour and Mini Mental State Examination (MMSE) scores preoperatively and on postoperative day 7. MMSE score ≤23 was considered evidence of cognitive dysfunction. Postoperative confusion or agitation, medications administered for postoperative agitation, and hospital length of stay were also recorded. Data were analyzed with Student’s t-test, Pearson’s correlation or multiple regression analysis as appropriate.Results:Patient age was 74±13 years. Baseline left sided rSO2 values were 60±10 and increased significantly after intubation. Baseline rSO2 L<50 and <45 was observed in 11.6% and 10.1% of patients respectively. Perioperative cerebral desaturation occurred in 40% of patients. MMSE score was 26.23 ± 2.77 before surgery and 25.94 ± 2.52 on postoperative day 7 (p=0.326). MMSE scores ≤ 23 were observed preoperatively in 6 and postoperatively in 9 patients. Patients with cognitive dysfunction had lower preoperative hematocrit, hemoglobin, SpO2 and rSO2 values at all times, compared to patients who did not. There was no correlation between rSO2 or POCD and hospital stay. Patients with baseline rSO2 <5 required more medications for postoperative agitation.Conclusion:Cognitive dysfunction occurs preoperatively and postoperatively in elderly patients with hip fractures, and is associated with low cerebral rSO2 values.
We report a case of thoracic trauma (rib fractures with pneumothorax and pulmonary contusions) with severe chest pain leading to ineffective ventilation and oxygenation. The patient presented to our emergency department. The patient had chronic obstructive pulmonary disease and was completely unable to take deep breaths and clear secretions from his bronchial tree. After obtaining informed consent, we applied auricular acupuncture to ameliorate pain and hopefully improve his functional ability to cough and breathe deeply. Within a few minutes, his pain scores diminished considerably, and his ventilation and oxygenation indices improved to safe limits. Auricular acupuncture analgesia lasted for several hours. Parallel to pain reduction, hemodynamic disturbances and anxiety significantly resolved. A second treatment nearly a day later resulted in almost complete resolution of pain that lasted at least 5 days and permitted adequate ventilation, restored oxygenation, and some degree of mobilization (although restricted due to a compression fracture of a lumbar vertebra). Nonopioid and opioid analgesics were sparsely used in low doses during the entire hospitalization period. Hemodynamic alterations and anxiety also decreased, and the patient was soon ready to be discharged.
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