Therapeutic effect of hyperbaric oxygen on delirium of elderly patients after total knee arthroplasty

Abstract

Objective To observe the effect of hyperbaric oxygen (HBO) on postoperative delirium in elderly patients after total knee arthroplasty under general anesthesia. Methods A total of 194 patients were classified as American Society of Anesthesiologists (ASA) Ⅱ-Ⅲ according to the ASA physical status classification and received total knee arthroplasty surgery under general anesthesia in Yantaishan Hosptial from October 2017 to July 2019. All subjects were randomly divided into HBO group and control group according to random number table method, with 97 cases in each group. The patients in the control group received knee replacement surgery under general anesthesia, cocktail regional analgesia during the closure of wounds, and intravenous analgesia pump after operation. The patients in the HBO group received HBO at 1 day before surgery and the 1st to 3rd day after surgery, based on the same anesthesia scheme of the control group. The mean arterial pressure (MAP), heart rate (HR) of the two groups at different points in time and visual analog scale (VAS) of 48 h after operation were recorded. The incidences of delirium of the two groups 5 d after surgery were evaluated by the confusion assessment method for the intensive care unit (CAM-ICU). Results There was no statistical significance in the comparisons of MAP and HR at different points in time respectively (P>0.05) when the patients were taken to the operating room (T1), 1 minute after the insertion of laryngeal mask (T2), before the start of the surgery (T3), 30 minutes after the start of the surgery (T4), before the removal of the laryngeal mask (T5), taken to the post-anesthesia care unit immediately after surgery (T6), and taken out of the post-anesthesia care unit (T7). There was no significant difference in VAS scores between the two groups at 6, 24, and 48 hours after surgery (P>0.05). The incidence of postoperative delirium in the HBO group (9.2%) was significantly lower than that in the control group (28.9%), with statistical significance (P<0.05). Conclusion HBO can significantly reduce the incidence of postoperative delirium in elderly patients after total knee arthroplasty, which is worthy of popularization and application in clinic. Key words: Hyperbaric oxygen; Elderly patients; Total knee arthroplasty; Postoperative delirium