JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) An erratum has been published Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Casati, A. Search for Related Content PubMed PubMed Citation Articles by Casati, A.

---

TECHNOLOGY, COMPUTING, AND SIMULATION

Continuous Monitoring of Cerebral Oxygen Saturation in Elderly Patients Undergoing Major Abdominal Surgery Minimizes Brain Exposure to Potential Hypoxia

Andrea Casati, MD^*, Guido Fanelli, MD^*, Paolo Pietropaoli, MD, Rodolfo Proietti, MD, Rosalba Tufano, MD, Giorgio Danelli, MD^*, Giuseppe Fierro, MD, Germano De Cosmo, MD, Giovanni Servillo, MD on behalf of the Collaborative Italian Study Group on Anesthesia in Elderly Patients

*Department of Anesthesiology, Azienda Ospedaliera di Parma - Università degli Studi di Parma – Parma; Department of Anesthesiology, Policlinico Universitario Umberto I–Università degli Studi di Roma – Roma; Department of Anesthesiology, Policlinico Gemelli, Università Cattolica di Roma – Roma; Department of Anesthesiology, Policlinico Universitario Federico II di Napoli - Napoli

Address correspondence and reprint requests to Andrea Casati, MD, Department of Anesthesiology, Azienda Ospedaliera di Parma, Via Gramsci 14–43100 Parma. Address e-mail to acasati{at}ao.pr.it.

Elderly patients are more prone than younger patients to develop cerebral desaturation because of the reduced physiologic reserve that accompanies aging. To evaluate whether monitoring cerebral oxygen saturation (rSO₂) minimizes intraoperative cerebral desaturation, we prospectively monitored rSO₂ in 122 elderly patients undergoing major abdominal surgery with general anesthesia. Patients were randomly allocated to an intervention group (the monitor was visible and rSO₂ was maintained at 75% of preinduction values; n = 56) or a control group (the monitor was blinded and anesthesia was managed routinely; n = 66). Cerebral desaturation (rSO₂ reduction <75% of baseline) was observed in 11 patients of the treatment group (20%) and 15 patients of the control group (23%) (P = 0.82). Mean (95% confidence intervals) values of mean rSO₂ were higher (66% [64%–68%]) and the area under the curve below 75% of baseline (AUCrSO2₂< 75% of baseline) was lower (0.4 min% [0.1–0.8 min%]) in patients of the treatment group than in patients of the control group (61% [59%–63%] and 80 min% [2–144 min%], respectively; P = 0.002 and P = 0.017). When considering only patients developing intraoperative cerebral desaturation, a lower Mini Mental State Elimination (MMSE) score was observed at the seventh postoperative day in the control group (26 [25–30]) than in the treatment group (28 [26–30]) (P = 0.02), with a significant correlation between the AUCrSO₂ < 75% of baseline and postoperative decrease in MMSE score from preoperative values (r²= 0.25, P = 0.01). Patients of the control group with intraoperative cerebral desaturation also experienced a longer time to postanesthesia care unit (PACU) discharge (47 min [13–56 min]) and longer hospital stay (24 days [7–53] days) compared with patients of the treatment group (25 min [15–35 min] and 10 days [7–23 days], respectively; P = 0.01 and P = 0.007). Using rSO₂ monitoring to manage anesthesia in elderly patients undergoing major abdominal surgery reduces the potential exposure of the brain to hypoxia; this might be associated with decreased effects on cognitive function and shorter PACU and hospital stay.

This article has been cited by other articles:

				T. M. Hemmerling, M. C. Bluteau, R. Kazan, and D. Bracco Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry Br. J. Anaesth., October 3, 2008; (2008) aen275v1. [Abstract] [Full Text] [PDF]

				G. W. Fischer Recent Advances in Application of Cerebral Oximetry in Adult Cardiovascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 60 - 69. [Abstract] [PDF]

				A. Denault, A. Deschamps, and J. M. Murkin A Proposed Algorithm for the Intraoperative Use of Cerebral Near-Infrared Spectroscopy Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 274 - 281. [Abstract] [PDF]

				A. Bekker, M. Haile, K. Gingrich, L. Wenning, A. Gorny, D. Quartermain, and T. Blanck Physostigmine Reverses Cognitive Dysfunction Caused by Moderate Hypoxia in Adult Mice Anesth. Analg., September 1, 2007; 105(3): 739 - 743. [Abstract] [Full Text] [PDF]

				J. M. Murkin, S. J. Adams, R. J. Novick, M. Quantz, D. Bainbridge, I. Iglesias, A. Cleland, B. Schaefer, B. Irwin, and S. Fox Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study Anesth. Analg., January 1, 2007; 104(1): 51 - 58. [Abstract] [Full Text] [PDF]

				J. M. Murkin Neurologic complications in noncardiac surgery. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 125 - 127. [Abstract] [PDF]

				G. M. Hoffman Neurologic Monitoring on Cardiopulmonary Bypass: What Are We Obligated to Do? Ann. Thorac. Surg., June 1, 2006; 81(6): S2373 - S2380. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999