Effects Of Different Anesthetic Methods On Postoperative Delirium In Cardiac Surgery Under Cardiopulmonary Bypass

Objective:Postoperative delirium is a common complication after general anesthesia and surgery.It is a comprehensive manifestation of acute brain organ dysfunction.It is a kind of consciousness disorder accompanied by the decline of attention and concentration ability,consciousness disorder,cognitive ability change or perception disorder,especially in the aged.This disturbance of consciousness usually appears shortly and fluctuates after surgery(from a few hours to three days after surgery).Up to now,the pathogenesis of postoperative delirium has not been standardized and unified,and some research results suggest that it may be caused by multiple pathophysiological mechanisms.Postoperative delirium is also a common complication after cardiac surgery.It has been shown that the use of desflurane and propofol as the primary anesthetic has no difference in the incidence of delirium in cardiac surgery after 24 hours and in total knee arthroplasty after 48 h in elderly patients.But now related research about the influence of desflurane combined with propofol on postoperative delirium is still less,this study intends to explore that in the cardiac surgery under cardiopulmonary bypass,the use of different anesthesia methods---propofol in intravenous anesthesia or desflurane-propofol in intracvenous inhalational anethesia,influences on postoperative delirium,for looking for the best anesthesia method of cardiac surgery under cardiopulmonary bypass and providing a basis to prevent and reduce the occurrence of postoperative delirium.Methods: Patients in the cardiac surgery department of our hospital who met the admission criteria were randomly assigned to the following groups by SPSS random number generation method(20191101): group P: anesthesia maintained by propofol-dexmedetomidine;group I: anesthesia maintained by desflurane-propofol-dexmedetomidine.The general information of the patients was recorded as follows:name,age,gender,height,weight,total intraoperative dose of heparin,protprotine dose,minimum nasopharyngeal temperature,dosage of various anesthetic induction drugs,cardiopulmonary bypass time of the patients,duration of ascending aortic occlusion and operative duration.At 48 hours after surgery,analgesia was assessed by using visual analogue scale(VAS),delirium was assessed by using Richmond Agitation-Sedation Scale(RASS)and Confusion Assessment Method For the Intensive Care Unit(CAM-ICU),and cognitive was assessed by using Mini-mental State Examination(MMSE)in the ICU.Results: A total of 34 patients successfully are rolled in this experiment,including 18 patients in group P and 16 patients in group I.There are no statistical significance in gender,age,height,weight,total intraoperative dose of heparin,total protamine dose and minimum nasopharyngeal temperature(℃)between 2 groups(P >0.05).There are no significant differences in the dosage of each induction of anesthetic,the dose of dexmedetomidine and cisatracurium during intraoperative maintenance between group P and group I(P >0.05).The result of CAM-ICU delirium assessment in both groups has obvious statistical significance difference(P < 0.05),the results of VAS score,cognitive evaluation of MMSE score difference in both groups are statistically significant(P < 0.05),the pain score,delirium assessment,cognitive score results in group I are better than group P,the result of RASS score has no obvious statistical significance in both groups.Conclusion: In cardiac surgery under cardiopulmonary bypass,the incidence of delirium 48 hours of surgery with intravenous inhalational anesthesia combined with desflurane and propofol is lower than that intravenous anesthesia with propofol,and patients with intravenous inhalational anesthesia combined with desflurane has better early postoperative cognitive function than those with propofol.