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Br J Anaesth. 2012 Apr;108(4):623-9. doi: 10.1093/bja/aer501. Epub 2012 Feb 5.

Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction.

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  • 1Department of Anaesthesiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Canada.

Abstract

BACKGROUND:

The objective of this prospective study is to determine cognitive dysfunction after thoracic surgery.

METHODS:

Seventy-six patients undergoing thoracic surgery with single-lung ventilation (SLV) of an expected duration of >45 min were enrolled. Monitoring consisted of standard clinical parameters and absolute oximetry (S(ct)O(2)). The Mini-Mental State Exam (MMSE) test was used to assess cognitive function before operation and at 3 and 24 h after operation. Data were analysed using Spearman correlation test; risks for cognitive dysfunction were expressed as odds ratios. P<0.05 and data are presented as median (interquartile range).

RESULTS:

One patient was excluded from the study. S(ct)O(2) during SLV decreased to critical values of <65%, 60%, and 55% in 40 (53%), 15 (20%), and 5 patients (7%), respectively. Twenty-two patients (29%) had a decrease of MMSE>2 points 3 h after surgery, eight patients (10%) had a decrease of MMSE>2 points 24 h after surgery. Postoperative cognitive dysfunction correlated at r(2)=0.272, 0.285, 0.297 with patient exposure times to S(ct)O(2)<65% (P=0.018), <60% (P=0.013), <55% (P=0.010), respectively. The odds ratios of developing early cognitive dysfunction ranged from 2.03 (95% CI: 0.74-5.59) for a short (<5 min) exposure to S(ct)O(2)<65% to a maximum of 9.56 (95% CI: 1.75-52.13) when S(ct)O(2) was <60% for more than 30 min.

CONCLUSIONS:

Early cognitive dysfunction after thoracic surgery with SLV is positively related to intraoperative decline of S(ct)O(2).

PMID:
22311364
[PubMed - indexed for MEDLINE]
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