Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery

Abstract

BackgroundPostoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients.MethodsThis prospective study recruited 120 geriatric patients who underwent hip surgery. The patients were randomly divided into two groups: control group (NS group) and HS group. Patients in the NS group were pre-injected with 4 mL/kg isotonic saline, and those in the HS group were pre-injected with 4 mL/kg 7.5% HS. All 120 patients were then subjected to general anesthesia. Blood samples were extracted to detect the concentration of inflammatory factors, namely, IL-1β, IL-6, IL-10, and TNF-α, and the nerve injury factor S100β. Flow cytometry was used to detect the number of monocytes in peripheral venous blood and evaluate the relationship of inflammation to delirium. The nursing delirium screening scale (Nu-DESC) was used to determine cognitive function 1 to 3 days postoperatively.ResultsAnalysis using random-effect multivariable logistic regression indicated that HS administration before anesthesia was associated with a low risk of POD (odds ratio [OR], 0.13; 95% CI, 0.04 to 0.41; P = 0.001) and few CD14 + CD16+ monocytes (β = − 0.61; 95% CI, − 0.74 to − 0.48; P = 0.000) the following day. When the association between HS and delirium was controlled for CD14 + CD16+ monocytes, the effect size became nonsignificant (odds ratio [OR], 0.86; 95% CI, 0.14 to 5.33; P = 0.874). TNF-α was significantly associated with POD (odds ratio [OR], 1.10; 95% CI, 1.05 to 1.16; P = 0.000). However, IL-1β, IL-6, IL-10, and S100β were not significantly related to POD.ConclusionHS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes.

Electric vagal nerve stimulation inhibits inflammation and improves postoperation cognitive dysfunction in aged rats

“…Our results showed that the surgery and general anesthesia could produce damage to memory and study capability, and aggravate POCD in elderly rats, because the surgery and general anesthesia induce systemic-and neuro-inflammation [19]. Although the improvement of cognitive function was not significantly, electrical VNS did reduce the development of POCD in some degree.…”

“…After the surgery, the number of crossing (F=0.302, P=0.587) and the number of rearing (F=2.040, P=0.148) were also similar in three groups, but the number of crossing (11.85±15.44) and rearing (2.62±3.30) in SV group were higher than the number of crossing (10.00±13. 19) and rearing (1.80±2.82) in S group (Figure 6).…”

Electric vagal nerve stimulation inhibits inflammation and improves early postoperation cognitive dysfunction in aged rats

“…There were no significant different between three groups on body weight (F = 0.073, P = 0.930) and basic heart rate (F = 1.163, P = 0.326) ( 19) rose up, compared to C group (369.60±21.46) (P = 0.021). Till to ten minute after stopping VNS, heart rates were not significantly different between three groups (F = 0.230, P = 0.796), and recovered to the basic level ( Figure 2).…”

Electric vagal nerve stimulation inhibits inflammation and improves early postoperation cognitive dysfunction in aged rats

“…After the operation, the number of crossing (F=0.302, P=0.587) and the number of rearing (F=2.040, P=0.148) were also similar in three groups, but the number of crossing (11.85±15.44) and rearing (2.62±3.30) in SV group were higher than the number of crossing (10.00±13. 19) and rearing (1.80±2.82) in S group (Figure 6).…”