Karan Nupur, Bansal Sonia, Mehta Urvakhsh Meherwan, Chakrabarti Dhritiman, Reddy Madhusudan
Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
Clin Neurol Neurosurg. 2023 Apr;227:107642. doi: 10.1016/j.clineuro.2023.107642. Epub 2023 Feb 24.
Delayed neurocognitive recovery (DNR) is commonly seen in patients in the postoperative period. Literature has shown that monitoring cerebral desaturation intraoperatively can predict the development of DNR in elderly patients undergoing surgery in prone position. This prospective observational study was conducted in patients of all ages, with the primary objective to determine the incidence of DNR and its correlation with cerebral oximetry. The secondary objectives were to determine if intraoperative cerebral desaturation influenced the neuropsychometric variables from preoperative to postoperative period.
This study included 61 patients, aged > 18 years undergoing spinal surgery in prone position. An evening before surgery and at 48 h postoperatively, patients were subjected to neuropsychological examination; Hindi Mental State Examination, Colour Trail Test 1 (CTT 1), CTT 2, Auditory Verbal Learning (AVLT) tests conducted by principal investigator (PI). DNR was defined as a 20% change in any of the test scores from the baseline. rSO was recorded bilaterally every 10 min throughout surgery by an independent person. Cerebral desaturation was defined as a 20% drop in rSO from the control value.
The incidence of DNR was 24.6%. The duration of anesthesia and cerebral desaturation were found to be independently predictive of DNR, with each hour of anesthesia causing a two-fold increase in the chances of development DNR (P = 0.019) and presence of cerebral desaturation causing a 6-fold increase (P = 0.039). CTT 1 and CTT 2 tests had significantly larger increase in test scores in the postoperative period, in patients with cerebral desaturation.
Duration of anesthesia and cerebral desaturation were factors predictive of the development of DNR in patients undergoing spine surgery in prone position.
延迟性神经认知恢复（DNR）在术后患者中很常见。文献表明，术中监测脑氧饱和度可预测老年俯卧位手术患者DNR的发生。本前瞻性观察性研究针对所有年龄段的患者进行，主要目的是确定DNR的发生率及其与脑氧饱和度的相关性。次要目的是确定术中脑氧饱和度下降是否会影响术前至术后的神经心理测量变量。
本研究纳入了61例年龄大于18岁的俯卧位脊柱手术患者。术前一晚及术后48小时，患者接受神经心理学检查；由主要研究者（PI）进行印地语精神状态检查、色线试验1（CTT 1）、CTT 2、听觉言语学习（AVLT）测试。DNR定义为任何测试分数相对于基线变化20%。在整个手术过程中，由独立人员每10分钟双侧记录一次rSO。脑氧饱和度下降定义为rSO较对照值下降20%。
DNR的发生率为24.6%。发现麻醉持续时间和脑氧饱和度下降是DNR的独立预测因素，每增加一小时麻醉，DNR发生几率增加两倍（P = 0.019），脑氧饱和度下降会使发生几率增加6倍（P = 0.039）。在脑氧饱和度下降的患者中，CTT 1和CTT 2测试在术后期间的测试分数有显著更大的增加。
麻醉持续时间和脑氧饱和度下降是俯卧位脊柱手术患者发生DNR的预测因素。
