The Effects Of Stomach Positioning On Postoperative Cognitive Dysfunction In Orthopedics Patients During General Anesthesia

Objective To explore the effects of general anesthesia on early postoperative cognitive dysfunction of patients who are given orthopedic operations on stomach positions.Methods160patients were chosen by Qianfoshan Hospital in Shandong Province for elective orthopedic surgery (such as femoral neck fracture fixation, knee replacement surgery and spinal canal decompression and posterior fixation), ASAI～Ⅱ grade level, ages spread from60to70years old, weighing between55kg to80kg, cardiac function class I or II level, but no systemic diseases in respiratory, circulation and endocrine, all the patients were divided into two groups (dorsal group and stomach group) according to randomized controlled trial principle, each group contains80cases. General anesthesia was used for all the patients, after intravenous rapid induction, we intubation successfully, then infuse propofol and remifentanil continuous and intermittent bolus injection of muscle relaxants and analgesics to maintain a appropriate depth of anesthesia. Using bispectral monitor and maintain the BIS value between40and50, multi-function monitor was used for continuous monitoring of heart rate (HR), pulse oximetry (SPO2), mean arterial pressure (MAP) and end-tidal carbon dioxide partial pressure (PETCO2) throughout the operative course, and record these value at five time points respectively,which is Before induction (T1), after intubation (T2),10minutes after intubation (T3), after extubation (T4) and10minutes after extubation (T5). MMSE was used for cognitive function detect at the moment of day before(Ml、6hours(M2)、1day(M3)、3days(M4) after surgery and before discharge(M5) to identify POCD. POCD was diagnosed by the MMSE scores acquired by the time of M2, record and analysis the data obtain from the5time to evaluate the recovery status.Results To calculate and analysis the general situation、intraoperative hemodynamic data、the percentage of POCD in two groups^MMSE scores at five time points statistically. The results demonstrate:(1) Patients in the two groups was not different significant in sex, age, height, body weight statistically (P>0.05);(2)Heart rate (HR), oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PETCO2) in two groups at each time point dose not change significantly (P>0.05); Mean arterial pressure (MAP) decreased at10minutes after intubation(T3) in stomach group compared with the time before induction(T1) with statistical significance (P<0.05);(3) the percentage of cases was identified as POCD in dorsal group is less than the stomach group;(4) MMSE is carried out for cognitive function detect at the time of the day before(M1)、6hours(M2)、1day(M3)、3days(M4) after surgery and before discharge(M5) to identify POCD. Compared with M1moment, differences were statistically significant in M2,M3and M4moment in D groups (P<0.05);while the differences were statically significant in M2,M3in group S (P<0.05); comparison between the groups:the scores of MMSE were lower in group S than group D.(P<0.05)。Conclusion Maintain the BIS values at40-50, POCD occurred in two positions with orthopedic surgery under general anesthesia, but the patient in dorsal group recovered faster than the stomach group.