Effects Of Sevoflurane And Propofol On Cerebral Oxygen Saturation And Postoperative Delirium In Patients Undergoing Laparoscopic Colon Cancer Surgery

Objective:To observe the changes of regional cerebral oxygen saturation（r SO₂）in the Trendelenburg position（T position）by near-infra red spectroscopy（NIRS）,and to investigate the effects of intraoperative anesthetic maintenance drugs on cerebral oxygen tissue to investigate the effect of intraoperative anesthetic maintenance drugs on the balance of brain oxygen supply and demand and the occurrence of postoperative delirium（POD）.Methods:Sixty patients undergoing elective laparoscopic colon cancer surgery in the central hospital between December 2021 and December 2022were prospectively selected and divided into two groups using the random number table method:the sevoflurane group as the S group and the propofol group as the P group.The electrocardiogram（ECG）,blood pressure（BP）,finger pulse oxygen saturation（SPO₂）and r SO₂ were monitored,radial artery puncture and cannulation were performed,optic nerve sheath diameter（ONSD）was measured after entering the operating room.The right internal jugular vein was punctured and cannulated under anesthesia,and the patient was observed from T0 to T6 including 10 minutes after entering the room（T0）,the time after tracheal intubation（T1）,the time after 30 degrees of T position（T2）,30 minutes after 30 degrees of T position（T3）,60 minutes after 30 degrees of T position（T4）,120 minutes after 30 degrees of T position（T5）,and r SO₂,mean arterial pressure（MAP）,stroke volume variation（SVV）,ONSD,the end-tidal partial pressure of carbon dioxide（Pet CO₂）,hemoglobin（Hb）and arterial partial pressure of carbon dioxide（Pa CO₂）were analyzed by collecting radial artery blood at T0,T4,T6.The blood where is in the bulb of the internal jugular vein was collected and analyzed for jugular venous bulb oxygen saturation（Sjv O₂）from T0 to T6.The enzyme linked immunosorbent assay（ELISA）was used to measured serum neuron-specific enolase（NSE）and S100βprotein concentrations at day 1before surgery（D0）,day 1（D1）,day 2（D2）and day 3（D3）after surgery.Neuropsychological tests were performed by the same anesthesiologist on the mini mental state examination（MMSE）at the day before surgery,the score≥27 indicates normal.The incidence of POD and NRS>3 was screened and the number of postoperative complications was recorded using the confusion assessment method（CAM）on the three postoperative days.Results:There was no significant difference between group S and group P（P>0.05）in these experimental results including the preoperative general condition;the volume of fluid which was absorbed and outflowed during surgery;frequency of vasoactive drugs;the MAP,SVV,Pet CO₂,r SO₂ from T0 to T6;the Hb,Pa CO₂ at T0,T4 and T6;the number of postoperative complications and the number of patients with NRS>3 score.The S100βprotein concentration and NSE concentration measured at D1,D2 and D3 in group S and group P were significantly higher compared to D0（P<0.05）,and group S was significantly increased than group P（P<0.05）;the Sjv O₂ valued at T3,T4,T5 and T6 moments were significantly increased in group S than group P（P<0.05）;ONSD values were significantly increased in group S than group P（P<0.05）;The incidence of postoperative POD was significantly increased in group S than in group P（P<0.05）.Conclusion:Compared with sevoflurane,there was no difference in the change of r SO₂,and the increase of ONSD value,Sjv O₂,serum S100βprotein and NSE concentration was smaller compared with the baseline level,and the incidence of POD was lower when propofol was applied for anesthesia maintenance.The application of propofol in patients undergoing laparoscopic colon cancer surgery could better maintain the balance of cerebral oxygen supply and demand,and it could also reduce the occurrence of postoperative delirium.