Effect of Anesthetic Methods on Cerebral Oxygen Saturation in Elderly Surgical Patients: Prospective, Randomized, Observational Study

• Published in: World journal of surgery 2012-10, Vol.36 (10), p.2328-2334
• Main Authors: Lee, Aerina, Kim, Sung-Hoon, Hong, Jeong-Yeon, Hwang, Jai-Hyun
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Anesthesia, Inhalation; Anesthesia, Spinal; Brain - metabolism; Cardiac Surgery; Cerebral Oxygen; Deep Sedation; General Surgery; Humans; Male; Mean Arterial Pressure; Medicine; Medicine & Public Health; Monitoring, Intraoperative; Oxygen - metabolism; Postoperative Cognitive Dysfunction; Prospective Studies; Spinal Anesthesia; Spinal Block; Surgery; Thoracic Surgery; Transurethral Resection of Prostate; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1676-z

Background Intraoperative cerebral oxygen desaturation was reported to be associated with postoperative cognitive dysfunction in elderly patients. The effect of the anesthesia method on regional cerebral oxygen saturation (rSO 2 ) is still a question under debate. The purpose of this study was to compare the effects of three common anesthesia methods on intraoperative rSO 2 changes in elderly patients. Methods In this prospective randomized clinical trial, 87 patients scheduled for elective transurethral prostatectomy were allocated to receive general inhalational anesthesia (GA group, n  = 30), spinal anesthesia (SA group, n  = 28), or spinal anesthesia plus sedation with midazolam (SA+S group, n  = 29). Results The numbers of patients showing a decrease in rSO 2 below the baseline value were higher in the SA (92.9 %) and SA+S (100 %) groups than in the GA group (33.3 %). The number of patients with a ≥50 % decrease in rSO 2 below baseline was greater in the SA+S (31.0 %) group than in the GA (0 %) or SA (3.6 %) group. During surgery, patients subjected to general anesthesia had higher rSO 2 than those with spinal anesthesia. Blood pressures and heart rates were similar in three groups except 5 and 10 min after anesthesia. Intraoperative SpO 2 was higher in the GA group than in the two spinal anesthesia groups. Conclusions Spinal anesthesia is associated with more frequent cerebral desaturation than general anesthesia; and it was aggravated when combined with midazolam sedation. The cerebral effects of anesthesia should be considered when managing high-risk elderly patients.