| Part1 Effects of sevoflurane and propofol anesthesia on intraoperative hemodynamics,postoperative cognitive function and short-term prognosis in elderly cancer patientsObjective: To investigate the effects of sevoflurane and propofol anesthesia on intraoperative hemodynamics,postoperative cognitive function and short-term prognosis in elderly cancer patients.Methods: 300 eligible individuals undergoing elective radical resection for carcinoma,ASA?~?,aged 65~86 years,BMI 18~25 kg/m2,were randomly assigned into either receiving sevoflurane(group S)or propofol anesthesia(group P),150 cases in each.The induction of anesthesia was performed with propofol,sufentanil and rocuronium in surgical groups.The anesthesia was maintained with sevoflurane in group S and propofol in group P.The perioperative depth of anesthesia was guided by bispectral index(BIS)monitor ranging from 40 to 60.Evaluated the demographic parameters,mini-mental state examination(MMSE),educational level and complications in surgical patients before surgery.Recorded mean arterial pressure(MAP)and heart rate(HR)in 6 time points:before anesthesia induction(T0),before intubation(T1),at intubation(T2),at skin incision(T3),at using surgical retractor or establishing pneumoperitoneum(T4),at the end of operation(T5).Measured the intraoperative dosages of sufentanil and rocuronium,frequency of vasoactive drugs,BIS values,fruit transfusion,blood loss,frequency of red blood cell,urine volume,surgical techniques and sites,and duration of surgery and anesthesia.After surgery,collected the time of opening eyes and extubation,incidence of shivering and agitation,length of post-anesthetic care unit(PACU)stay.In the ward,collected the postoperative anus exhausting time,occurrence of complications and length of hospital stay.And recorded the frequency of Postoperative Ausea and Vomiting(PONV),Numerical Rating Scale(NRS)and global score of Quality of Recovery-40(Qo R-40)in the first 7 days after surgery.Measured the all-cause mortality,re-hospitalized for treatment and second operation in 30 days postoperatively,and the all-cause mortality,re-hospitalized for treatment,second operation,and incidence of recurrence or metastasis in 3 months following surgery.And the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(EORTC QLQ-C30)was calculated at 3 months after surgery.Performed the assessment of delirium by the Confusion Assessment Method(CAM)at 8 time points,the day before and the first 7 days after surgery,measured the occurrenceand duration of postoperative delirium(POD).Neuropsychological tests were performed to evaluate the cognitive function in surgical groups the day before,at 7 days and 3 months after surgery.60 elderly health volunteers were also recruited as the controlled group(group C),assessed with the same neuropsychological tests at the same intervals in time.According to the results of neuropsychological tests and conducted a Z-score to evaluate and define the occurrence of postoperative cognitive dysfunction(POCD)in surgical groups.A multivariate Logistic regression model was conducted to analyze the risk factors of POCD at 7 days and 3 months after surgery.Results: There were no significant differences in general information between three groups(P>0.05).At T0 ~ T5,MAP and HR in group P were similar with group S(P>0.05).During surgery,there were no significant differences in the dosages of sufentanil and rocuronium,frequency of vasoactive drugs,average value of BIS,fruit transfusion,blood loss,frequency of red blood cell,urine volume,surgical techniques and sites,duration of surgery and anesthesia between two surgical groups(P>0.05).In PACU,the opening and extubation time were longer in group P than group S(P<0.05),and the duration of PACU stay was similar between surgical groups(P>0.05).In the ward,postoperative anus exhausting time,occurrence of complications and length of hospital stay in group S did not differ from group P(P>0.05).In the first 3 days following surgery,the frequency of PONV wasmore in group S than group P(P<0.05),the score of NRS was higher in group S than group P(P<0.05),and the global score of Qo R-40 was lower in group S than group P(P<0.05).In the first 7 days after surgery,there was no significantly differences in the total incidence and duration of POD between two surgical groups(P>0.05).In the first 6 days after surgery,the incidence of POCD in group S was similar with group P respectively(P>0.05).At 7th days following surgery,no patient suffered with POD in two groups.Compared with the results in group C at the corresponding time point,the scores of Visual Verbal Learning Test(included immediate and delay memory)and Letter-Digit Coding Test were significantly declined in group S and group P(P<0.05),and the completing time of Concept Shifting Test and Stroop Color Word Test were significantly increased in group S and group P at 7 days after surgery(P<0.05).There were no significant differeces in the results of neuropsychological tests and the incidence of POCD between surgical groups(P>0.05).At 3 months after surgery,there were no differences in the results of neuropsychological tests amang the three groups(P>0.05),and there was no significant difference in the rate of POCD between surgical groups(P>0.05).At 30 days after surgery,there were no significantly difference in the incidence of all-cause mortality,re-hospitalized for treatment and secondary operation between surgical groups(P>0.05).At 3 months after surgery,there were no significantly difference in the incidence of all-cause mortality,re-hospitalized for treatment,secondary operation,incidence of recurrence or metastasis,scores of EORCT QLQ-C30 between surgical groups(P>0.05).The results of Logistic analyse showed that aged(?75 years),duration of surgery and anesthesia(>240min),blood loss during surgery(?500ml),perioperative transfusion of red blood cells,infection of incisional wound after surgery and POD were the independent risk factors of POCD at 7 days after surgery,and POCD at 7 days after treatment was the independent risk factor of POCD at 3 months following surgery.Conclusion: During surgery,Maintaining anesthesia with sevoflurane and propofol were stable in hemodynamics in the elderly cancer patients.Compared with propofol anesthesia,sevoflurane anesthesia could shorten the opening and extubation time in PACU,decline the quality of recovery in the early postoperative period.Furthermore,the incidence of POD and POCD,and the short-term prognosis after sevoflurane anesthesia were similar to that of propofol anesthesia in elderly cancer patients.Part2 Effect of preoperative chemotherapy with oxaliplatin on postoperative cognitive function in elderly cancer patientsObjective: To investigate the effect ofpreoperative chemotherapy with oxaliplatin on postoperative cognitive function in elderly cancer patients.Methods: 100 eligible individuals undergoing elective radical resection for gastric,colorectal and rectal carcinoma with total intravenous anesthesia,aged65~79 years,ASA ? ~ ? grades,BMI 18~25 kg/m2,the Tumor-Node-Metastasis(TNM)classification stage ? or ?,were assigned into two groups according to the history of preoperative chemotherapy with oxaliplatin: preoperative chemotherapy group(group PC)and non-preoperative chemotherapy group(group NC),50 cases in each.The induction and maintenance of anesthesia were performed with propofol,sufentanil and rocuronium in surgical groups.The perioperative depth of anesthesia was guided by bispectral index(BIS)monitor ranging from 40 to 60.Evaluated the demographic parameters,mini-mental state examination(MMSE),educational level and complications in surgical patients before surgery.Measured the BIS values,blood loss,surgical techniques,operative sites,duration of surgery and anesthesia,dosages of anesthetics,frequency of vasoactive drugs during surgery.Collected the time of opening eyes and extubation,occurrence of shivering and agitation,length of post-anesthetic care unit(PACU)stay.Recorded the postoperative occurrence of complications and length of hospital stay.Performed the assessment of delirium by the Confusion Assessment Method(CAM)at 8 time points,the day before and the first 7 days after surgery,measured the occurrenceand duration of postoperative delirium(POD).And neuropsychological tests were performed to evaluate the cognitive dysfunction in surgical groups the day before and at 7 days after surgery.25 elderly health volunteers were also recruited as the controlled group(group C),assessed with the same neuropsychological tests at the same intervals in time.According to the results of neuropsychological tests,performed a Z-score to evaluate and define the occurrence of postoperative cognitive dysfunction(POCD)in surgical groups.Conducted telephone interview by cognitive status-modified(TICS-m)to define mild cognitive impairment(MCI)and dementia(AD)for all surgical patients at 4 weeks after surgery.A multivariate Logistic regression model was conducted to analyze the risk factors of POCD at 7 days after surgery.Results: There were no significant differences in general information between three groups(P > 0.05).During surgery,there were no significant differences in the average value of BIS,blood loss,surgical techniques and sites,duration of surgery and anesthesia,dosages of propofol,sufentanil and rocuronium,frequency of vasoactive drugs between two surgical groups(P>0.05).There were no significantly difference in the total incidence and duration of POD between two surgical groups(P>0.05).In the first 5 days after surgery,the incidence of POCD in group PC was similar with group NC respectively(P>0.05).At 6 daysand 7 days following surgery,no patient suffered with POD in two groups.Compared with the results in group C at the corresponding time point,the scores of Visual Verbal Learning Test(immediate and delay memory)and Letter-Digit Coding Test were significantly declined in two surgical groups(P<0.05),and the completing time of Concept Shifting Test and Stroop Color Word Test were significantly prolonged in two surgical groupsat 7 days after surgery(P<0.05).Compared with the results of neuropsychological testsin group NC at 7 days after surgery,the scores of Visual Verbal Learning Test(included immediate)and Letter-Digit Coding Test were significantly declined in group PC(P<0.05).The incidence of POCD was higher in group PC than group NC(P<0.05).The postoperative length of hospital stay was longer in group PC than group NC(P<0.05).Compared with group NC at 4 weeks following surgery,the score of TICS-m was significantly decreased(P<0.05),the incidence of MCI was significantly increased in group PC(P<0.05).The results of Logistic analyse showed that aged(?75 years)and preoperative chemotherapy with oxaliplatin were the independent risk factors of POCD at 7 days after surgery.Conclusion: Preoperative chemotherapy with oxaliplatin in the elderly cancer patients could exacerbate cognitive impairment caused by general anesthesia and surgical procedures in the early postoperative period,resulted in the incidence of POCD and MCI increased significantly,and postoperative length of hospital stay prolonged significantly.Part3 Effect of anesthetic depth on postoperative cognitive function in elderly cancer patientsObjective: To investigate the effect of difference depth of anesthesia on postoperative cognitive function in elderly cancer patients Methods: 200 eligible individuals undergoing elective radical resection for carcinoma,ASA?~?,aged65~86 years,BMI 18~25 kg/m2,were randomly assigned into BIS-guided anesthesia group(group B)or routine care group(group R),100 cases in each.The induction and maintenance of anesthesia were performed with propofol,sufentanil and rocuronium in surgical groups.The perioperative depth of anesthesia was guided by bispectral index(BIS)monitor ranging from 40 to 60 in group B,whereas anesthetic performance and BIS monitoring were separated in group R.Evaluated the demographic parameters,mini-mental state examination(MMSE),educational level and complications in surgical patients before surgery.Measured the BIS values,blood loss,surgical techniques,operative sites,duration of surgery and anesthesia,intraoperative dosages of propofol,sufentanil and rocuronium,frequency of vasoactive drugs.Collected the time of opening eyes and extubation,incidence of shivering and agitation,length of post-anesthetic care unit(PACU)stay.In the ward,measured the occurrence of perioperative awareness,time of postoperative exhaust,occurrence of complications and length of hospital stay.Performed the assessment of delirium by the Confusion Assessment Method(CAM)at 8 time points,the day before and inthe first 7 days after surgery,measured the occurrenceand duration of postoperative delirium(POD).Neuropsychological tests were performed to evaluate the cognitive dysfunction in group B and group R the day before,at 7 days and 3 months after surgery.50 elderly health volunteers were also recruited as the controlled group(group C),assessed with the same neuropsychological tests at the same intervals in time.According to the results of neuropsychological tests,performed a Z-score to evaluate and define the occurrence of postoperative cognitive dysfunction(POCD)in surgical groups.Results: There were no significant differences in general information between three groups(P>0.05).During surgery,the average value of BIS was higher in group B than group R(P<0.05),and the dosage of propofol was lower in group B than in group R(P<0.05).There were no significant differences in the blood loss,surgical techniques and sites,duration of surgery and anesthesia,frequency of vasoactive drugs,dosages of sufentanil and rocuronium between surgical groups(P>0.05).In PACU,the time of opening,extubation,and PACU stay in group B were shorter than group R(P<0.05).In the ward,the time of postoperative exhaust and length of hospital stay were significantly decreased in the group B compared with group R(P<0.05).And there were no significant differences in the occurrence of perioperative awareness and postoperative complications between two surgical groups(P>0.05).In the first 7 days after surgery,the total incidence of POD was lower in group B than group R(P<0.05),andthe duration of POD was shorter in group B than group R(P<0.05).In the first 6 days after surgery,the incidence of POCD in group B was similar with group R respectively(P>0.05).At 7 days following surgery,no patient suffered with POD in two surgical groups.Compared with the results in group C at the corresponding time point,the scores of Visual Verbal Learning Test(included immediate and delay memory)and Letter-Digit Coding Test were significantly declined in group B and group R(P<0.05),and the completing time of Concept Shifting Test and Stroop Color Word Test were significantly prolonged in group B and group R at 7 days after surgery(P<0.05).Compared with the results in group R at 7 days after surgery,the scores of Visual Verbal Learning Test(included immediate and delay memory)were higher in group B(P<0.05),and the completing time of Stroop Color Word Test was shortened in group B(P<0.05).There was no significant difference in the occurrence of POCD between two surgical groups(P>0.05).There were no differences in the results of neuropsychological tests between three groups at 3 months later(P>0.05).There was no significant difference in the incidence of POCD between two surgical groups(P > 0.05).A multivariate Logistic regression model was conducted to analyze the risk factors of POD in the first 7 days and POCD at 7 days and 3 months after surgery.The results of Logistic analyse showed that advanced age(?75 years)and continuous deep anesthesia(BIS<40,?30min)were the independent risk factors of POD in the first 7 days after surgery.Advanced age(?75 years),duration of anesthesia and surgery(>240min),and POD were the independent risk factors of POCD at 7 days after surgery.And advanced age(?75 years)was the independent risk factors of POCD at 3 months after surgery.Conclusion: During surgery,the maintenance of anesthetic depthby BIS ranging from 40 to 60 could prevent the occurrence of intraoperative awareness,reduce the dosage of anesthetic agents,shorten the time of anesthetic recovery and postoperative duration of hospital stay,decrease the incidence of POD,shorten the duration of POD and attenuate impairment of cognitive function in the early postoperative period,which could enhance postoperative recovery for elderly cancer patients. |
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