Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial

Abstract

IntroductionPostoperative delirium is an important problem in patients undergoing major surgery. Cerebral oximetry is a non-invasive method to detect imbalances in the cerebral oxygen supply/demand-ratio. Low preoperative cerebral oxygen saturation (ScO2) levels have been associated with postoperative delirium in non-cardiac surgery patients. The present prospective observational study determines the relationship between pre- and intra-operative ScO2 levels and postoperative delirium in patients undergoing on-pump cardiac surgery.MethodsAfter approval of the local ethical committee and written informed consent, N = 231 patients scheduled for elective/urgent cardiac surgery were enrolled. Delirium was assessed by the confusion-assessment-method for the intensive care unit (CAM-ICU) on the first three days after surgery. ScO2 was obtained on the day before surgery, immediately before surgery and throughout the surgical procedure. Preoperative cognitive function, demographic, surgery related, and intra- and post-operative physiological data were registered.ResultsPatients with delirium had lower pre- and intra-operative ScO2 readings, were older, had lower mini-mental-status-examination(MMSE) scores, higher additive EuroScore and lower preoperative haemoglobin-levels. The binary logistic regression identified older age, lower MMSE, neurological or psychiatric disease and lower preoperative ScO2 as independent predictors of postoperative delirium.ConclusionsThe presented study shows that a low preoperative ScO2 is associated with postoperative delirium after on-pump cardiac surgery.

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

“…5 Low cerebral saturation correlates with postoperative delirium and postoperative cognitive deficit. 6 Thoracotomy is reported to be associated with a very high incidence of cerebral desaturation when one-lung ventilation (OLV) is instituted. 5,7 The mechanism of cerebral desaturation in this context is unclear because, in the majority of cases, pulse oximetry indicates that arterial oxygen saturation remains well within clinically acceptable levels.…”

Monitorisation of Cerebral Oxygenation in Cardiac Surgeries with and Without Cardiotomy

“…Postoperatif yoğun bakım ünitesinde kalma süreciy-le, operasyon boyunca düşük seyreden rSO 2 değerleri arasında bir bağlantı olduğunu yapılan bazı yayınlar rapor ederken [7,9,[13][14][15][16] başka çalışmalar 2'si arasında bir bağlantı bulunmadığını ileri sürmüştür [17,18] . Ça-lışmamızda, intraoperatif rSO 2 değerlerinde olduğu gibi postoperatif yoğun bakımda kalış süresi ve eks-tübasyon zamanları ile ilgili olarak da gruplar arasın-da fark bulunmamıştır.…”

Arterial Oxygenation and Management of Hypoxemia During VATS

“…In particular, the suggestion of a potential association with postoperative complications is concerning [28], but further research is required to define the underlying mechanism and delineate its significance.…”