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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.

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