The Relationship Between Intraoperative Anesthetic Management And Postoperative Cognitive Dysfunction In Elderly Patients

Objective: To observe and analyze the elderly patients in different anesthesia management mode on the effect of early and long-term cognitive dysfunction after operation and the changes of serum S100? protein and A? levels.Methods: One hundred elderly patients who were scheduled to receive abdominal surgery under general anesthesia were divided into routine monitoring group?group R,n=50?and multiple monitoring group?group M,n=50?.They were divided at random with a number list.After entering the operating room,patients were routinely monitored by SpO₂,ECG,HR and IBP.In addition,patients in group M were monitored Narcotrend?NT?,regional cerebral oxygen saturation?rSO₂?and TOF at the same time.All patients were carried out the same induction : intravenous injection of midazolam 0.01⁰.05mg/kg,etomidate 0.1⁰.3mg/kg,cisatracurium 0.1⁰.2mg/kg,sufentanil citrate 0.2⁰.4ug/kg.Mainten anesthesia with propofol and remifentanil during operation.The infusion rate of propofol,remifentanil and cisatracurium was adjusted by skilled anesthesiologists according to their experiences by the patients' monitoring index in group R,while in group M,the anesthesiologists modulated anesthetic drugs to make NTI of 37⁵6 and make rSO₂ maintain more than 50% or not lower than the baseline value by 20%.Keep PETCO₂ between 35⁴5mmHg?1mm Hg =0.133KPa?,SpO₂ more than 98% and temperature?T?in 36.0³7.0 ?and the life signs were kept adequately in the anesthetic maintenance.Such parameters as body mass index,gender,age,education level,preoperative complications,operation time,anesthesia time,postoperative eye opening time?t1?,extubation time?t2?,orientation recovery time?t3?,titrated dosage of propofol,remifentanil and cisatracurium in two groups were compared.The changes of rSO₂ and NTI were observed at these time points of before induction?T0?,after induction?T1?,intubation moment?T2?,at the beginning of the operation?T3?,at the end of operation?T4?,postoperative eye opening time?T5?,pulling out the tracheal tube?T6?,orientation recovery?T7?.Cognitive function of patients in the two groups were evaluated using MMSE 1 day before and 1 day,3 days,7 days,1 month and 3 months after surgery.Morbidity of postoperative cognitive dysfunction?POCD?and intraoperative awareness were calculated.Blood were randomly selected from each group which were determined the serum content of S100? and A? by ELISA method at the time point of before surgery,one hour after starting surgery,the end of surgery and postoperative 24 hours.Results:1 The age,gender,BMI,education level,preoperative complications and other general information in two groups have no significant difference.?P>0.05?.2 There were no significant difference in the anesthesia time,operative time,VAS score and titrated dosage of remifentanil in the two groups?P>0.05?.Compared with group M,the titrated dosage of propofol and cisatracurium in group R were higher and the differences were statistically significant?P<0.05?.3 Compared with group M,the time of t1?t2?t3 in group R were longer and the difference was statistically significant?P<0.05?.Patients' NTI gradually increased at the three stages of eye opening,extubation,orientation recovery in group M and the difference was statistically significant?P<0.01?.Compared with T0,the rSO₂ value in T1?T2?T3?T4 was higher and the difference was statistically significant?P<0.05?.4 The cases of POCD on 1 days,3 days,7 days,one month,there months after surgery were 11,8,6,6,4 in group R,while in group M were 4,1,1,1,1.Compared with group M,the incidence of POCD on the 1 day and 3 days after surgery in group R was higher.The difference was statistically significant?P<0.05?.5 Compared with T0,the concentration of serum S100? protein in group R was higher at T1,T2,T3?P<0.05?,while in group M the concentration of serum S100? protein was higher at T1 and T2?P<0.05?.Compared with group M,the concentration of serum S100? protein in group R was higher at T1,T2,T3?P<0.05?.The difference of increment concentration of serum S100? protein was statistically significant at T2 and T3?P<0.05?.6 Compared with T0,the A?1-42 protein level were lower at T1,T2 in the two groups and the difference was statistically significant?P<0.05?.But there were no significant differences in the two groups.Conclusion:1 Multiple monitoring group can reduce the titrated dosage of propofol and cisatracuriumn and shorten the eye-opening time,extubation time and orientation recovery time.2 Multiple monitoring group can reduce the level of S100 beta protein in serum of elderly patients,and reduce the incidence of cognitive dysfunction in the early postoperative period.