Value Of Intraoperative Cerebral Oxygen Saturation Monitoring In Predicting Postoperative Delirium In Infants Undergoing Robot Assisted Laparoscopic Pyeloplasty

Objective:To explore the predictive value of intraoperative cerebral oxygen saturation（rSO₂）monitoring for postoperative delirium（POD）in infants undergoing robot assisted laparoscopic pyeloplasty,and to establish a predictive model.Methods:From December 2020 to October 2021,a total of 30 children with hydronephrosis,aged 1～3 years and ASA grade Ⅰ～Ⅱ were collected.All of them underwent robot assisted laparoscopic pyeloplasty under general anesthesia.The following indexes were recorded:（1）General conditions:age,gender,BMI,fasting and water deprivation time,operation and anesthesia time,fentanyl dosage,fluid dosage,bleeding volume,urine volume and extubation time;（2）Before anesthesia induction（T0）,rSO₂base value,pulse oxygen saturation（Sp O₂）,heart rate（HR）,blood pressure and temperature（T）were recorded,and then the rSO₂and the values of vital signs such as mean arterial pressure（MAP）of children were recorded respectively after intubation（T1）,pneumoperitoneum for 5 minutes（T2）,pneumoperitoneum for 0.5 hours（T3）,pneumoperitoneum for 1 hour（T4）,pneumoperitoneum for 2 hours（T5）,5 minutes after pneumoperitoneum（T6）and 5minutes after extubation（T7）.Respiratory parameter values of children at T1～T6 were recorded,mainly including end-tidal carbon dioxide partial pressure(P_ETCO₂)and peak inspiratory pressure（PIP）.Arterial blood was drawn at T1,T4～T6 for blood gas analysis,and the partial pressure of carbon dioxide in arterial blood（Pa CO₂）and other relevant values were recorded.Taking the rSO₂at T0 as the baseline value,mark the minimum value of rSO₂（rSO₂min）and the average value of rSO₂（rSO₂mean）,and calculate the maximum percentage drop in rSO₂（rSO₂%max）;（3）The postoperative rehabilitation and the occurrence of complications such as nausea,vomiting and pain within 7 days were evaluated.The venous blood was drawn and the levels of serum interleukin-6（IL-6）,S-100beta protein（S-100β）and neuron specific enolase（NSE）were detected by enzyme linked immunosorbent assay（ELISA）.The occurrence of POD in children was evaluated within 20 minutes after extubation according to the pediatric anesthetized delirium（PAED）score scale,and they were divided into delirium group（POD group）and non delirium group（NPOD group）.Logistic regression analysis was conducted to compare meaningful variables between groups to obtain the risk factors that may lead to POD.Receiver operating characteristics（ROC）curve was used to evaluate the predictive value of rSO₂change on POD.Results:1.General data:a total of 30 children were included in this study,including 15 in POD group and 15 in NPOD group.There was no significant difference between POD group and NPOD group（P>0.05）.2.The indexes of HR,MAP,T,P_ETCO₂,PIP and blood gas analysis showed a certain fluctuation trend in the observation period（P<0.05）.At T4 time point,Pa CO₂in POD group was significantly lower than that in NPOD group（P<0.05）.3.There was no significant difference in postoperative nausea and vomiting,complications and rehabilitation between the two groups（P>0.05）.One day after operation,the pain score in POD group was significantly higher than that in NPOD group（P<0.05）.4.The detection of serum inflammatory factors found that there was no significant difference in IL-6,S-100βand NSE between POD group and NPOD group at each time point（P>0.05）,but NSE showed a certain fluctuation trend at different time points（P<0.05）.Compared with that before operation,the level of NSE in POD group increased significantly at 3 days after operation（P<0.05）.5.The rSO₂was recorded at T0～T7 time points,and the results of satistical analysis were as follows:（1）The intraoperative rSO₂of the two groups showed a certain fluctuation trend at different time points（P<0.05）;（2）There was significant difference in rSO₂between the two groups（P<0.05）;（3）At T1,T2 and T4～T7 time points,rSO₂in POD group was significantly lower than that in NPOD group（P<0.05）;（4）Compared with NPOD group,rSO₂min and rSO₂mean in POD group decreased significantly,and rSO₂%max in POD group increased significantly（P<0.05）.6.Logistic regression analysis showed that rSO₂%max was an independent risk factor for POD.7.ROC curve analysis showed that when the intraoperative rSO₂%max was 3.18%,the yoden index was the largest,sensitivity was 77.3%,specificity was 86.7%,and the area under AUC curve was 0.840,indicating that the diagnostic efficiency of this test was high.Conclusion:rSO₂%max is an independent risk factor for POD in infants undergoing robot assisted laparoscopic pyeloplasty.Intraoperative rSO₂%max>3.18%has early warning significance for the occurrence of postoperative delirium,and low rSO₂%max can reduce the level of postoperative inflammatory factors and reduce brain injury.The nomogram prediction model established by rSO₂%max can accurately predict the occurrence of POD and provide help for POD prevention and diagnosis.