Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia

Andrea Casati, Guido Fanelli, Paolo Pietropaoli, Rodolfo Proietti, Rosalba Tufano, Giorgio Danelli, Giuseppe Fierro, Germano De Cosmo, Giovanni Servillo, Massimiliano Nuzzi, Federico Mentegazzi, Andrea Fanelli, Carla Martani, Emanuela Spreafico, Francesco Pugliese, Paola Aceto, Fabrizio Monaco

Research output: Contribution to journalArticle

Abstract

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 (rSO 2 reduction 2 were higher (66% [64%-68%]) and the area under the curve below 75% of baseline (AUCrSO2 2 <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 AUCrSO 2 <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.

Original languageEnglish
Pages (from-to)740-747
Number of pages8
JournalAnesthesia and Analgesia
Volume101
Issue number3
DOIs
Publication statusPublished - Sep 2005

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Casati, A., Fanelli, G., Pietropaoli, P., Proietti, R., Tufano, R., Danelli, G., Fierro, G., De Cosmo, G., Servillo, G., Nuzzi, M., Mentegazzi, F., Fanelli, A., Martani, C., Spreafico, E., Pugliese, F., Aceto, P., & Monaco, F. (2005). Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesthesia and Analgesia, 101(3), 740-747. https://doi.org/10.1213/01.ane.0000166974.96219.cd