Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study

Zhang, Na; Liang, Min; Zhang, Dandan; Xiao, Yi-rong; Li, Yanzhen; Gao, Youguang; Cai, Hong-da; Lin, Xiaoxi; Lin, Chi-Chung; Zeng, Kai; Wu, Xiaodan

doi:10.1016/j.ijsu.2018.04.007

Cited by 24 publications

(18 citation statements)

References 15 publications

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“…This reduces the risk of excessive fluid administration. Whereas an earlier observational study reported a 75% reduction in postoperative delirium incidence with goal-directed fluid therapy in spinal surgery, 131 a recent clinical trial has reported no significant difference. 132 It is, however, worth noting that both studies have small patient size and likely lack statistical power.…”

Section: Intravenous Fluid and Blood Products Administrationmentioning

confidence: 89%

Postoperative delirium: perioperative assessment, risk reduction, and management

Jin

2020

British Journal of Anaesthesia

311

263

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Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2e3 days and is associated with a 30-day mortality of 7e10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.

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Section: Intravenous Fluid and Blood Products Administrationmentioning

confidence: 89%

Postoperative delirium: perioperative assessment, risk reduction, and management

Jin

2020

British Journal of Anaesthesia

311

263

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“…18 Additionally, it has been recently suggested that more efficient maintenance of normocapnia and cardiac blood flow (by applying a goal directed fluid therapy strategy) might also decrease postoperative cognitive impairment in elderly patients undergoing noncardiac surgery. 4,19 We hypothesized that a closed-loop management of (1) anesthetic depth (via processed EEG monitoring), (2) cardiac blood flow (via stroke volume optimization), and (3) lung ventilation (via optimization of tidal volume and respiratory frequency to maintain predefined end-tidal carbon dioxide [ETco 2 ] targets) using three independent controllers would outperform manual control of these variables, and as a result, patients would present with less postoperative neurocognitive impairment compared to patients having standard, manually adjusted anesthesia.…”

Section: Editor's Perspectivementioning

confidence: 99%

Anesthetic Management Using Multiple Closed-loop Systems and Delayed Neurocognitive Recovery

et al. 2020

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Cognitive changes after anesthesia and surgery represent a significant public health concern. We tested the hypothesis that, in patients 60 yr or older scheduled for noncardiac surgery, automated management of anesthetic depth, cardiac blood flow, and protective lung ventilation using three independent controllers would outperform manual control of these variables. Additionally, as a result of the improved management, patients in the automated group would experience less postoperative neurocognitive impairment compared to patients having standard, manually adjusted anesthesia. Methods In this single-center, patient-and-evaluator-blinded, two-arm, parallel, randomized controlled, superiority study, 90 patients having noncardiac surgery under general anesthesia were randomly assigned to one of two groups. In the control group, anesthesia management was performed manually while in the closed-loop group, the titration of anesthesia, analgesia, fluids, and ventilation was performed by three independent controllers. The primary outcome was a change in a cognition score (the 30-item Montreal Cognitive Assessment) from preoperative values to those measures 1 week postsurgery. Secondary outcomes included a battery of neurocognitive tests completed at both 1 week and 3 months postsurgery as well as 30-day postsurgical outcomes. Results Forty-three controls and 44 closed-loop patients were assessed for the primary outcome. There was a difference in the cognition score compared to baseline in the control group versus the closed-loop group 1 week postsurgery (–1 [–2 to 0] vs. 0 [–1 to 1]; difference 1 [95% CI, 0 to 3], P = 0.033). Patients in the closed-loop group spent less time during surgery with a Bispectral Index less than 40, had less end-tidal hypocapnia, and had a lower fluid balance compared to the control group. Conclusions Automated anesthetic management using the combination of three controllers outperforms manual control and may have an impact on delayed neurocognitive recovery. However, given the study design, it is not possible to determine the relative contribution of each controller on the cognition score.

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“…Published literature describing the use of GDFT in spine surgeries is limited ( 6 , 13 , 53 , 54 ). Dynamic indices such as pulse pressure variation, stroke volume variation, corrected flow time, and plethysmography index variability have been commonly used to predict fluid responsiveness among GDFT trials ( Table 1 ) ( 33 , 34 , 55 , 56 ).…”

Section: Physiologic Changes During Prone Positioningmentioning

confidence: 99%

“…Dynamic indices such as pulse pressure variation, stroke volume variation, corrected flow time, and plethysmography index variability have been commonly used to predict fluid responsiveness among GDFT trials ( Table 1 ) ( 33 , 34 , 55 , 56 ). Significant reduction in blood loss and blood transfusion, fewer post-operative respiratory complications, faster return of bowel function after surgery, shorter length of stay, reduced number, and duration of hypotensive episodes, and decreased incidence of nausea, vomiting and post-operative delirium have been reported with the use of GDFT in patients undergoing spine surgeries ( 6 , 13 , 53 ). The last finding is attributed to a reduction of peripheral inflammatory markers IL-6 and S100β and becomes of particular interest as fluid balance has been described as a modifiable risk factor of post-operative delirium in this patient setting ( 14 ).…”

Section: Physiologic Changes During Prone Positioningmentioning

confidence: 99%

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

et al. 2020

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Fluid management has been widely recognized as an important component of the perioperative care in patients undergoing major procedures including spine surgeries. Patient-and surgery-related factors such as age, length of the surgery, massive intraoperative blood loss, and prone positioning, may impact the intraoperative administration of fluids. In addition, the type of fluid administered may also affect post-operative outcomes. Published literature describing intraoperative fluid management in patients undergoing major spine surgeries is limited and remains controversial. Therefore, we reviewed current literature on intraoperative fluid management and its association with post-operative complications in spine surgery.

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Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study

Cited by 24 publications

References 15 publications

Postoperative delirium: perioperative assessment, risk reduction, and management

Postoperative delirium: perioperative assessment, risk reduction, and management

Anesthetic Management Using Multiple Closed-loop Systems and Delayed Neurocognitive Recovery

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

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