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Original Research

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Effect of patient end-tidal carbon dioxide levels on cerebral regional oxygen saturation and inflammatory cytokine concentrations in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial

  • Yan-lin Yan1,†
  • Liu-rong Lin2,3,†
  • Kai Zeng2
  • Hong-da Cai2
  • Cai-zhu Lin2
  • Min Liang2,*,
  • Yan-zhen Li2,*,

1Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, 350001 Fuzhou, Fujian, China

2Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, 350005 Fuzhou, Fujian, China

3Anesthesiology Research Institute, the First Affiliated Hospital, Fujian Medical University, 350005 Fuzhou, Fujian, China

DOI: 10.22514/sv.2022.073 Vol.18,Issue 6,November 2022 pp.59-65

Submitted: 17 June 2022 Accepted: 12 August 2022

Published: 08 November 2022

*Corresponding Author(s): Min Liang E-mail: min.liang@fjmu.edu.cn
*Corresponding Author(s): Yan-zhen Li E-mail: liyanzhen@fjmu.edu.cn

† These authors contributed equally.

Abstract

Carbon dioxide levels can affect inflammation and cerebral regional oxygen saturation (rScO2), a pathophysiological indicator of early postoperative cognitive dysfunction (POCD).To compare the cerebral rScO2 and postoperative inflammation based on patient end-tidal carbon dioxide (PET CO2) levels in elderly patients undergoing laparoscopic radical gastrectomy. Ninety patients were randomly divided into three groups according to PET CO2 level: group L (low PET CO2, 36–40 mmHg), group C (control PET CO2, 41–45 mmHg) and group H (high PET CO2, 46–50 mmHg). Eighty-four patients (age, range: 60–80 years) scheduled to undergo radical laparoscopic gastrectomy were included in the final analysis. The indicated PET CO2 was maintained for patients in each group. Their intraoperative cerebral rScO2 was recorded at indicated timepoints (T0–T6) from arrival at the operating room to post-extubation. The Montreal Cognitive Assessment Test (MoCA) and changes in serum concentrations of inflammatory cytokines were measured at 1 h, 1d and 7 d after surgery. The cerebral rScO2 at T3 (1 h post-skin incision)–T5 (completion of skin sutures) was significantly higher in group H than in group L, while the MoCA score was not significantly different between group H and L (p > 0.05). At 1 h, 1 d and 7 d after surgery, the concentrations of inflammatory cytokines, including interleukin 6 (IL-6) and S100β, were significantly higher in group L than in group H (p < 0.05). At 1 h and 7 d after surgery, the inflammatory cytokines were significantly higher in group C than in group H. Our findings suggest that higher PET CO2 levels increased cerebral rScO2 and reduced the serum concentrations of IL-6 and S100β but may not affect the MoCA score in elderly patients after radical laparoscopic gastrectomy.


Keywords

Elderly patients; Cerebral oxygenation; Postoperative cognitive dysfunction; Inflammatory cytokines


Cite and Share

Yan-lin Yan,Liu-rong Lin,Kai Zeng,Hong-da Cai,Cai-zhu Lin,Min Liang,Yan-zhen Li. Effect of patient end-tidal carbon dioxide levels on cerebral regional oxygen saturation and inflammatory cytokine concentrations in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial. Signa Vitae. 2022. 18(6);59-65.

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