Effect of goal-directed fluid therapy on postoperative cognitive function in patients undergoing intracranial tumor resection

Abstract

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) on postoperative cognitive function in the patients undergoing intracranial tumor resection. Methods One hundred patients of both sexes, aged 45-64 yr, weighing 50-70 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective cerebral glioma or meningioma resection, were randomly divided into 2 groups(n=50 each) using a random number table: GDFT group (group G) and conventional fluid therapy group (group C). The mean arterial pressure was maintained at 65-110 mmHg, urine volume >0.5 ml·kg-1·h-1, and central venous pressure at 8-12 cmH2O in group C. In group G, GDFT was performed using FloTrac/Vigileo system, and the cardiac index was maintained at 2.5-4.0 L·min-1·m-2, stroke volume variation≤13%, mean arterial pressure at 65-110 mmHg, and stroke volume index at 35-47 ml/m2.The requirement for crystalloid and colloid, urine volume, blood loss, and requirement for vasoactive agents were recorded during operation.Before induction of anesthesia (baseline), when the dura of brain was opened, at the end of tumor removal, at the end of operation, and at 24 h after operation (T0-4), venous blood samples were taken to determine the concentrations of serum neuron-specific enolase (NSE) and S100β protein by enzyme-linked immunosorbent assay.The patient′s cognitive function was assessed using Mini-Mental State Examination at T0 and 7 days after operation (T5). Results Compared with the baseline value at T0, the serum NSE and S100β protein concentrations were significantly increased at T2-4 in the two groups (P 0.05). Conclusion GDFT based on FloTrac/Vililgeo system can reduce the damage to brains after operation, but it has no significant effect on postoperative cognitive function in the patients undergoing intracranial tumor resection. Key words: Fluid therapy; Cognition disorders; Neurosurgical procedures