Effect Of Goal-directed Management Of RScO₂ Monitoring On Postoperative Delirium In Elderly Patients With Esophageal Cancer

Objective To observe the effect of goal-directed anesthesia management with continuous Regional cerebral oxygen saturation（rSc O₂）monitoring on postoperative delirium（POD）in elderly patients undergoing thoracoscopic esophageal cancer radical surgery.Method A total of 76 patients,48 males and 28 famales,aged 65-80 years,falling into ASA physical status II or III,scheduled for elective thoracoscopic esophageal cancer radical surgery under general anesthesia combined with paravertebral nerve block,were divided into two groups using a random number table:observation group（n=37）and control group（n=39）.Both groups of patients undergoing double-lumen bronchial intubation for one-lung ventilation,the control group only used routine monitoring for anesthesia management,and the observation group added rSc O₂monitoring anesthesia management on the basis of the control group,in the observation group to maintain rSc O₂>65%or no more than 20%decrease from the baseline value(rSc O_2（ox）).The following indicators were observed and compared between the two groups:1.the occurrence of delirium within 7 days after surgery,PACU stay,length of hospital stay and postoperative complications were recorded;2.the use of intraoperative related drugs;3.HR,MAP,SPO₂,Lac and Pa CO₂were recorded without oxygen inhalation（T1）,10 minutes of ventilation in the lateral decubitus position after induction（T2）,30minutes of one lung ventilation in the lateral decubitus position（T3）and 1 minute after extubation（T4）.Results There were no significant differences in gender,age,BMI,ASA classification,preoperative Hb,preoperative rSc O₂and combining basic illness between the two groups（P>0.05）.There were no statistically significant differences in intraoperative blood loss,infusion volume,OLV time,and the use of propofol and remifentanil（p>0.05）.Compared with the control group,the observation group used ephedrine and phenylephrine in a higher proportion（P<0.05）;the observation group had higher MAP at T3 and T4（P<0.05）;at T3 and T4,Lac The value was low（P<0.05）;the incidence of postoperative delirium,respiratory complications,PACU stay time and hospital stay in the observation group were lower than those in the control group（P<0.05）.Conclusion Goal-directed anesthesia management with Regional cerebral oxygen saturation（rSc O₂）monitoring to maintain the balance of oxygen supply and demand in brain tissue can reduce the occurrence of postoperative delirium（POD）and other complications,shorten the hospital stay,improve the quality of life of patients,and provide clinical references.