Abstract

Background: Postoperative delirium (POD) might be associated with anesthetic management, but research has focused on choice or dosage of anesthetic drugs. We examined potential contributions of intraoperative ventilatory and hemodynamic management to POD.Methods: This was a sub-study of the ENGAGES-Canada trial (NCT02692300) involving non-cardiac surgery patients enrolled in Winnipeg, Canada. Patients received preoperative psychiatric and cognitive assessments, and intraoperatively underwent high-fidelity data collection of blood pressure, end-tidal respiratory gases and anesthetic agent concentration. POD was assessed by peak and mean POD scores using the Confusion Assessment Method-Severity (CAM-S) tool. Bivariate and multiple linear regression models were constructed controlling for age, psychiatric illness, and cognitive dysfunction in the examination of deviations in intraoperative end-tidal carbon dioxide (areas over (AOC) and under the curve (AUC)) on POD severity scores.Results: A total of 101 subjects [69 (6) years of age] were studied; 89 had comprehensive intraoperative hemodynamic and end-tidal gas measurements (data recorded at 1 Hz). The incidence of POD was 11.9% (12/101). Age, cognitive dysfunction, anxiety, depression, and intraoperative end-tidal CO2 (AUC) were significant correlates of POD severity. In the multiple regression model, cognitive dysfunction and AUC end-tidal CO2 (0.67 kPa below median intra-operative value) were the only independent significant predictors across both POD severity (mean and peak) scores. There was no association between cumulative anesthetic agent exposure and POD.Conclusions: POD was associated with intraoperative ventilatory management, reflected by low end-tidal CO2 concentrations, but not with cumulative anesthetic drug exposure. These findings suggest that maintenance of intraoperative normocapnia might benefit patients at risk of POD.

Highlights

  • Research has not explicitly focused on the effect of anesthetic management on postoperative delirium (POD) despite preliminary evidence that suggests this plays an important role [1,2,3]

  • We examined intraoperative anesthetic course comprising ventilatory and hemodynamic management and their individual or combined potential for impact on POD as correlated to established preoperative risk factors

  • We have recently hypothesized that the anesthetic agent might be a “strawman” [6] and suggest that intraoperative management of anesthesia is where the risk for POD potentially lies ‘(7, 8)

Read more

Summary

Introduction

Research has not explicitly focused on the effect of anesthetic management on postoperative delirium (POD) despite preliminary evidence that suggests this plays an important role [1,2,3]. We examined intraoperative anesthetic course comprising ventilatory and hemodynamic management and their individual or combined potential for impact on POD as correlated to established preoperative risk factors. We have recently hypothesized that the anesthetic agent might be a “strawman” [6] and suggest that intraoperative management of anesthesia is where the risk for POD potentially lies ‘(7, 8). Postoperative delirium (POD) might be associated with anesthetic management, but research has focused on choice or dosage of anesthetic drugs. We examined potential contributions of intraoperative ventilatory and hemodynamic management to POD

Methods
Results
Conclusion

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.