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Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis.

Salazar F, Doñate M, Boget T, Bogdanovich A, Basora M, Torres F, Gracia I, Fàbregas N - BMC Anesthesiol (2014)

Bottom Line: We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001).The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain.

ABSTRACT

Background: Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function.

Methods: Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms.

Results: We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).

Conclusions: Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.

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Least mean squares estimates of regional cerebral oxygen saturation (rSO2) in each hemisphere over time in patients with no cognitive changes (NC) and in patients who developed memory decline (MD). Both right and left rSO2 values decreased over the course of the procedure in both groups (P < 0.001). Patients with MD showed significant right-left asymmetry in rSO2 values (P = 0.0012) as well as a significant mean right-left rSO2 difference (P = 0.0034). Ind = induction. Tourn = tourniquet. Postop = postoperative.
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Figure 2: Least mean squares estimates of regional cerebral oxygen saturation (rSO2) in each hemisphere over time in patients with no cognitive changes (NC) and in patients who developed memory decline (MD). Both right and left rSO2 values decreased over the course of the procedure in both groups (P < 0.001). Patients with MD showed significant right-left asymmetry in rSO2 values (P = 0.0012) as well as a significant mean right-left rSO2 difference (P = 0.0034). Ind = induction. Tourn = tourniquet. Postop = postoperative.

Mentions: We observed no differences in the baseline rSO2 values of patients with only memory decline (15 patients) at three months and those with no change. Nonetheless, patients with memory decline showed greater asymmetry between left and right rSO2 values over the course of the study, evident in a significantly lower right-left ratio of rSO2 mean values; their mean difference between the right and left rSO2 values was also greater (Table 3) (range in difference, 1%–10.94%). Finally, the percentage of memory-decline patients who had right rSO2 reductions of >25% from baseline was higher than in the group with no cognitive changes (P = 0.0226). Figure 2 compares the right and left rSO2 values of patients with memory decline and without changes.


Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis.

Salazar F, Doñate M, Boget T, Bogdanovich A, Basora M, Torres F, Gracia I, Fàbregas N - BMC Anesthesiol (2014)

Least mean squares estimates of regional cerebral oxygen saturation (rSO2) in each hemisphere over time in patients with no cognitive changes (NC) and in patients who developed memory decline (MD). Both right and left rSO2 values decreased over the course of the procedure in both groups (P < 0.001). Patients with MD showed significant right-left asymmetry in rSO2 values (P = 0.0012) as well as a significant mean right-left rSO2 difference (P = 0.0034). Ind = induction. Tourn = tourniquet. Postop = postoperative.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4109378&req=5

Figure 2: Least mean squares estimates of regional cerebral oxygen saturation (rSO2) in each hemisphere over time in patients with no cognitive changes (NC) and in patients who developed memory decline (MD). Both right and left rSO2 values decreased over the course of the procedure in both groups (P < 0.001). Patients with MD showed significant right-left asymmetry in rSO2 values (P = 0.0012) as well as a significant mean right-left rSO2 difference (P = 0.0034). Ind = induction. Tourn = tourniquet. Postop = postoperative.
Mentions: We observed no differences in the baseline rSO2 values of patients with only memory decline (15 patients) at three months and those with no change. Nonetheless, patients with memory decline showed greater asymmetry between left and right rSO2 values over the course of the study, evident in a significantly lower right-left ratio of rSO2 mean values; their mean difference between the right and left rSO2 values was also greater (Table 3) (range in difference, 1%–10.94%). Finally, the percentage of memory-decline patients who had right rSO2 reductions of >25% from baseline was higher than in the group with no cognitive changes (P = 0.0226). Figure 2 compares the right and left rSO2 values of patients with memory decline and without changes.

Bottom Line: We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001).The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesia, Hospital Clinic de Barcelona, (Universitat de Barcelona), Barcelona, Spain.

ABSTRACT

Background: Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function.

Methods: Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms.

Results: We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).

Conclusions: Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.

Show MeSH
Related in: MedlinePlus