Abstract
BackgroundPostoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients.MethodsThis prospective study recruited 120 geriatric patients who underwent hip surgery. The patients were randomly divided into two groups: control group (NS group) and HS group. Patients in the NS group were pre-injected with 4 mL/kg isotonic saline, and those in the HS group were pre-injected with 4 mL/kg 7.5% HS. All 120 patients were then subjected to general anesthesia. Blood samples were extracted to detect the concentration of inflammatory factors, namely, IL-1β, IL-6, IL-10, and TNF-α, and the nerve injury factor S100β. Flow cytometry was used to detect the number of monocytes in peripheral venous blood and evaluate the relationship of inflammation to delirium. The nursing delirium screening scale (Nu-DESC) was used to determine cognitive function 1 to 3 days postoperatively.ResultsAnalysis using random-effect multivariable logistic regression indicated that HS administration before anesthesia was associated with a low risk of POD (odds ratio [OR], 0.13; 95% CI, 0.04 to 0.41; P = 0.001) and few CD14 + CD16+ monocytes (β = − 0.61; 95% CI, − 0.74 to − 0.48; P = 0.000) the following day. When the association between HS and delirium was controlled for CD14 + CD16+ monocytes, the effect size became nonsignificant (odds ratio [OR], 0.86; 95% CI, 0.14 to 5.33; P = 0.874). TNF-α was significantly associated with POD (odds ratio [OR], 1.10; 95% CI, 1.05 to 1.16; P = 0.000). However, IL-1β, IL-6, IL-10, and S100β were not significantly related to POD.ConclusionHS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes.
Highlights
Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism
Association between prophylactic hypertonic saline and delirium The independent variable was set as HS administered before anesthesia, and the dependent variable was set as the presence of delirium the following day in the multivariate models to evaluate the effect of HS on elderly patients with POD
In the multivariate analysis model, age, sex, American Society of Anesthesiologists (ASA) class, body mass index (BMI), duration of anesthesia, and comorbidities were compared between the non-delirium and total delirium groups
Summary
Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. Postoperative delirium (POD) is a common acute cerebral disorder that is characterized by sudden and transient disturbances in awareness, consciousness, and cognition [1, 2]. POD is an age-related syndrome, primarily occurring in the elderly population (> 65 years of age) and may be associated with increased morbidity, length of hospital stay, and patient care costs [3]. Aseptic surgery increases in inflammatory markers in serum and causes inflammationmediated, hippocampal-dependent, and cognitive dysfunctions. Increased serum levels of inflammatory cytokines postoperatively are associated with memory impairment, reactive microgliosis, and upregulated interleukin (IL)-1β expression in the hippocampus [6]. Inflammatory cytokines are mainly involved in postoperative cognitive delirium [8]
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