Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study.
OBJECTIVE
The aim of this prospective, observational study was to evaluate changes in regional cerebral oxygen saturation (rSO2) and incidence of intraoperative cerebral desaturation in a cohort of elderly patients undergoing major abdominal surgery.


METHODS
rSO2 was continuously monitored on the left and right sides of the forehead in 60 patients older than 65 yr (35 males and 25 females; ASA II-III; age: 72 +/- 5 yr; without pre-existing cerebral pathology, and baseline Mini Mental State Examination (MMSE) score >23) undergoing sevoflurane anaesthesia for major abdominal, non-vascular surgery >2 h.


RESULTS
Baseline rSO2 was 63 +/- 8%; cerebral desaturation (rSO2 decrease <75% of baseline or <80% in case of baseline rSO2 <50%) occurred in 16 patients (26%). The MMSE decreased from 28 +/- 1 before surgery to 27 +/- 2 on 7th postoperative day (P = 0.05). A decline in cognitive function (decrease in MMSE score > or = 2 points one week after surgery as compared to baseline value) was observed in six patients without intraoperative cerebral desaturation (13.6%) and six patients who had intraoperative cerebral desaturation (40%) (P = 0.057) (odds ratio: 4.22; CI95%: 1.1-16). Median (range) hospital stay was 14 (5-41) days in patients with an area under the curve of rSO2 <50% (AUCrSO2<50%) >10 min%, and 10 (4-30) days in those with an AUCrSO2<50% <10 min% (P = 0.0005).


CONCLUSIONS
In a population of healthy elderly patients, undergoing non-vascular abdominal surgery cerebral desaturation can occur in up to one in every four patients, and the occurrence of cerebral desaturation is associated with a higher incidence of early postoperative cognitive decline and longer hospital stay.
Casati
A
A
Università degli Studi di Parma, Department of Anaesthesiology, Parma, Italy. acasati@ao.pr.it
Fanelli
G
G
Pietropaoli
P
P
Proietti
R
R
Tufano
R
R
Montanini
S
S
Danelli
Giorgio
G
Nuzzi
Massimiliano
M
Mentegazzi
Federico
F
Torri
Giorgio
G
Martani
Carla
C
Spreafico
Emanuela
E
Fierro
Giovanni
G
Pugliese
Francesco
F
De Cosmo
Germano
G
Aceto
Paola
P
Servillo
Giuseppe
G
Monaco
Fabrizio
F
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects; D001921:Brain / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies
D010100:Oxygen