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

• Published in: BMC anesthesiology 2014-07, Vol.14 (1), p.58-58, Article 58
• Main Authors: Salazar, Fátima, Doñate, Marta, Boget, Teresa, Bogdanovich, Ana, Basora, Misericordia, Torres, Ferran, Gracia, Isabel, Fàbregas, Neus
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anxiety; Arthroplasty, Replacement, Knee - methods; Brain - metabolism; Cirurgia ortopèdica; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Female; Heart surgery; Humans; Male; Medical personnel; Memory; Memory Disorders - epidemiology; Memory Disorders - etiology; Monitoring, Intraoperative; Motor ability; Nervous system; Orthopedic surgery; Oximetria; Oximetry; Oxygen; Oxygen - metabolism; Patients; Postoperative Complications - epidemiology; Psychiatric Status Rating Scales; Quality of life; Recall; Statistical analysis; Trends; Values
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/1471-2253-14-58

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. 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 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. We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P