Mutch W Alan C, El-Gabalawy Renée, Girling Linda, Kilborn Kayla, Jacobsohn Eric
Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Canada North Concussion Network (www.CNCN.ca), Winnipeg, MB, Canada.
Front Neurol. 2018 Aug 17;9:678. doi: 10.3389/fneur.2018.00678. eCollection 2018.
Postoperative delirium (POD) might be associated with anesthetic management, but research has focused on choice or dosage of anesthetic drugs. We examined potential contributions of intraoperative ventilatory and hemodynamic management to POD. This was a sub-study of the ENGAGES-Canada trial (NCT02692300) involving non-cardiac surgery patients enrolled in Winnipeg, Canada. Patients received preoperative psychiatric and cognitive assessments, and intraoperatively underwent high-fidelity data collection of blood pressure, end-tidal respiratory gases and anesthetic agent concentration. POD was assessed by peak and mean POD scores using the Confusion Assessment Method-Severity (CAM-S) tool. Bivariate and multiple linear regression models were constructed controlling for age, psychiatric illness, and cognitive dysfunction in the examination of deviations in intraoperative end-tidal carbon dioxide (areas over (AOC) and under the curve (AUC)) on POD severity scores. A total of 101 subjects [69 (6) years of age] were studied; 89 had comprehensive intraoperative hemodynamic and end-tidal gas measurements (data recorded at 1 Hz). The incidence of POD was 11.9% (12/101). Age, cognitive dysfunction, anxiety, depression, and intraoperative end-tidal CO (AUC) were significant correlates of POD severity. In the multiple regression model, cognitive dysfunction and AUC end-tidal CO (0.67 kPa below median intra-operative value) were the only independent significant predictors across both POD severity (mean and peak) scores. There was no association between cumulative anesthetic agent exposure and POD. POD was associated with intraoperative ventilatory management, reflected by low end-tidal CO concentrations, but not with cumulative anesthetic drug exposure. These findings suggest that maintenance of intraoperative normocapnia might benefit patients at risk of POD.
术后谵妄（POD）可能与麻醉管理有关，但研究主要集中在麻醉药物的选择或剂量上。我们研究了术中通气和血流动力学管理对POD的潜在影响。这是加拿大ENGAGES试验（NCT02692300）的一项子研究，涉及加拿大温尼伯市纳入的非心脏手术患者。患者接受术前精神和认知评估，术中进行血压、呼气末呼吸气体和麻醉剂浓度的高保真数据收集。使用混淆评估方法-严重程度（CAM-S）工具通过POD峰值和平均评分评估POD。在检查术中呼气末二氧化碳偏差（曲线下面积（AUC）和曲线上面积（AOC））对POD严重程度评分的影响时，构建了控制年龄、精神疾病和认知功能障碍的双变量和多元线性回归模型。共研究了101名受试者[年龄69（6）岁]；89名患者进行了全面的术中血流动力学和呼气末气体测量（数据以1Hz记录）。POD的发生率为11.9%（12/101）。年龄、认知功能障碍、焦虑、抑郁和术中呼气末CO（AUC）是POD严重程度的显著相关因素。在多元回归模型中，认知功能障碍和呼气末CO的AUC（低于术中中位数0.67kPa）是POD严重程度（平均和峰值）评分的仅有的独立显著预测因素。麻醉剂累积暴露与POD之间无关联。POD与术中通气管理有关，表现为呼气末CO浓度低，但与麻醉药物累积暴露无关。这些发现表明，维持术中正常碳酸血症可能对有POD风险的患者有益。
