Effects Of Desflurane On Cerebral Oxygen Saturation And Early Postoperative Recovery In Elderly Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

ObjectiveTo study the effects of desflurane and propofol on the regional cerebral oxygen saturation,pulmonary shunt and early recovery of the elderly patients undergoing thoracoscopic radical resection of lung cancer.Objective to explore safer and more comfortable anesthesia methods,reduce postoperative complications,accelerate postoperative recovery,and improve the quality of recovery.MethodsEighty elderly patients with lung cancer undergoing thoracoscopic radical resection under general anesthesia in The Affiliated Cancer Hospital of Zhengzhou University from February to December 2020,aged 65～85 years,ASA grade I～III,were randomly divided into two groups:desflurane group（Group D）and propofol group（group C）,40 cases in each group.Anesthesia was maintained by inhalation of desflurane in group D and intravenous infusion of propofol in group C.The regional cerebral oxygen saturation（r Sc O₂）and heart rate（HR）were monitored and recorded before anesthesia induction（T₀）,two lung ventilation 15 minutes after endotracheal intubation（T₁）,15 minutes after one lung ventilation（OLV）（T₂）,30 minutes after OLV（T₃）,60 minutes after OLV（T₄）,15 minutes after return to two lung ventilation（T₅）,and at the end of operation（T₆）HR,mean arterial pressure（MAP）,pulse oxygen saturation（Sp O₂）.Central venous blood and radial artery blood were collected at T₁,T₂ and T₃ for blood gas analysis.Such as partial pressure of oxygen（Pa O₂）,partial pressure of carbon dioxide（Pa CO₂）were measured,and the intrapulmonary shunt rate（Qs/Qt）was calculated.The recovery time of spontaneous breathing,recovery time,extubation time and orientation recovery time of the two groups were recorded.Montreal Cognitive Assessment（Mo CA）and mini mental state examination（MMSE）were used to evaluate the cognitive function of the two groups on the first day before operation and the first,third and seventh day after operation.Results（1）There was no significant difference in gender,age,ASA classification,BMI,number of left and right lungs,preoperative hemoglobin content,preoperative oxygen partial pressure,one second rate of preoperative pulmonary function,OLV time,operation time,blood loss,infusion volume and urine volume between the two groups（P>0.05）.（2）There was no significant difference in Pa O₂,Pa CO₂ and Qs/Qt between the two groups at T₁,T₂ and T₃（P>0.05）.Compared with T₁,Pa O₂ decreased significantly and Qs/Qt increased significantly at T₂ and T₃（P<0.05）;（3）compared with group C,the r Sc O₂ values of left and right sides in group D were higher than those in group C at T₂～T₄（P<0.05）;compared with T₀,the r Sc O₂value of the two groups during OLV was significantly lower（P<0.05）;compared with T₁,the r Sc O₂ value of the two groups from T₂～T₆ was significantly lower（P<0.05）;compared with group C,MAP of group D was lower than that of group C at T₁ and T₂（P<0.05）;compared with T₀,MAP of T₂～T₅ time was significantly lower in the two groups（P<0.05）.There was no significant difference between the two groups in HR and Sp O₂（P>0.05）.（4）Compared with group C,the recovery time,recovery time,time of withdrawal and recovery time of directional force in group D were significantly shorter（P<0.05）;（5）There was no significant difference in Mo CA and MMSE cognitive function scores in the two groups on the one day before operation（P>0.05）;there was no significant difference in Mo CA and MMSE cognitive function scores in the two groups on the first,third and seventh days after operation（P>0.05）;compared with the one day before operation,the cognitive function scores of Mo CA and MMSE in the two groups was significantly lower than that of the one day before operation（P<0.05）.ConclusionsCompared with propofol anesthesia,desflurane anesthesia can reduce the decline of r Sc O₂ during OLV in elderly patients undergoing thoracoscopic radical resection of lung cancer,help to improve the balance of cerebral oxygen supply and demand during OLV,and improve the quality of recovery.However,there was no significant difference in intrapulmonary shunt,arterial oxygenation during OLV and early postoperative cognitive function,which provides a reference for desflurane anesthesia in elderly patients with thoracoscopic lung cancer radical operation.