https://orcid.org/0000-0002-4868-6043
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Abstract
Objective
Postoperative delirium (POD) seriously affects recovery of older persons, increasing their mortality rate after surgery. We aimed to evaluate preoperative oral saline administration on postoperative delirium in older persons undergoing spinal decompression.
Design
A randomised controlled trial in a large tertiary hospital.
Setting and Participants
A total of 76 older persons (≧65 years old) undergoing spinal surgery from May 2020 to January 2021.
Methods
Older persons (65–83 years old) who underwent elective spinal canal decompression were randomly grouped into either the control group (n = 38) or the intervention group (n = 38). The control group was forbidden from drinking 8 hours prior to the operation while the intervention group was administered 5 mL·kg−1 of normal saline 2 hours before anesthesia. Hemodynamic indicators, diagnostic biomarkers, preoperative mini-mental status scores, and intraoperative fluid dynamics were recorded at baseline and at various postoperative timepoints. Subjects were then scored for POD and postoperative pain.
Results
S100β protein was lowered in S1 (FS1 = 12.289, P <0.001) and S2 (FS2 = 12.440, P <0.001) in the intervention group while mean arterial blood pressure (FT1= 42.997, P<0.001) and heart rate (FT1= 8.974, P=0.004) were increased. The Ln c-reactive protein of the intervention group was lowered 1 day postoperatively (FS2 = 6.305, P = 0.014). The incidence of postoperative delirium in the control group was higher than in the intervention group (27.8% vs 8.3%, χ2 = 4.547, P = 0.033).
Conclusion
Preoperative oral saline can reduce the incidence of postoperative delirium in older persons by minimizing perioperative hemodynamic fluctuations and central nervous system damage.
Abbreviations
ASA, American Society of Anesthesiologists; BBB, Blood Brain Barrier; BIS, Business Information System; BMI, Body Mass Index; CAM, Confusion Assessment Method; CNS, Central Nervous System; CRP, C-reactive Protein; Hb, Hemoglobin; HR, Heart Rate; IL-6, Interleukin-6; MAP, Mean Arterial Blood Pressure; MMSE, Mini-mental State Examination; Nu-DESC, Nursing Delirium Screening Scale; PACU, Post-anesthesia Care Unit; PCIA, Patient Controlled Intravenous Analgesia; POD, Postoperative Delirium; POCD, Postoperative Cognitive Dysfunction; S100β, S100β Protein; VAS, Visual Analogue Scale.
Registration Information
Registration number: ChiCTR2100048640 Registration website: http://www.chictr.org.cn/ This study has been registered at 12/7/2021 The first patient registered in this study at 25/5/2020.
Data Sharing Statement
The data is available from the corresponding author upon the reasonable request.
Ethical Approval and Consent to Participate
This study was a single center, randomized controlled study. It was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University (Ethics Medical Research [2020] No. 155). All procedures performed in studies were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants in this study have provided informed written consent prior to enrollment.
Consent for Publication
Informed consent was obtained from all the participants and/or their legal guardian to publish their information.
Acknowledgments
We would like to thank the participants and peers for their participation in this study. Jinzhuan Chen and Siyu Xie are co-first authors for this study.
Disclosure
The authors have no conflicts of interest to declare in this work.