Effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in pa-tients with ankylosing spondylitis undergoing pedicle subtraction osteotomy
Effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in pa-tients with ankylosing spondylitis undergoing pedicle subtraction osteotomy
Objective To evaluate the effect of regulation of balance between cerebral oxygen sup-ply and demand on wake-up test in patients with ankylosing spondylitis(AS)undergoing pedicle subtraction osteotomy(PSO).Methods In this randomized controlled study,64 AS patients of either sex,aged 18-65 yr,with a body mass index of 18-25 kg/m2,of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ,undergoing PSO in Nanjing Drum Tower Hospital from July 2021 to April 2023,were assigned into intervention group(I group,n=32)and control group(C group,n=32).The regional cerebral oxygen satruation(rSO2)breathed in a lateral position after entering the operating room was consid-ered as baseline.In group M,rSO2 was maintained within 10％of the baseline value:Lowering the partial pressure of end-tidal CO2 and mean arterial pressure,increasing the consumption of propofol and giving mannitol were countermeasures against an elevated rSO2＞10％of baseline;whereas elevating partial pres-sure of end-tidal CO2 and mean arterial pressure and increasing the concentration of inhaled oxygen,and transfusing red blood cells were performed in AS patients with a rSO2＜10％of baseline in I group.A routine anesthesia management and rSO2 monitoring were performed in C group.The rSO2 was recorded on admission to the operating room in a quiet lateral position(T0),10 min after tracheal intubation(T,),10 min after the placement of the"arch bridge"position(T2),30 min after the start of operation(T3),at the end of osteotomy(T4),at the time point of intraoperative awakening(T5),30 min after awakening(T6),and at the end of operation(T7).The occurrence of increase and decrease in rSO2＞10％of the baseline(for 5 min)during the pre-awakening stage and throughout operation was recorded.The wake-up quality was as-sessed during the wake-up test.The wake-up time,Ramsay Sedation Scale scores and Riker Sedation-Agita-tion Scale scores were recorded.The length of stay in postanesthesia care unit and extubation time were also recorded.Delirium was assessed during emergence from anesthesia using the Confusion Assessment Method for the intensive care unit.The Visual Analogue Scale score was recorded to assess the pain.Results Com-pared with group C,rSO2 was significantly decreased at T3-T5,rSO2 was increased at T6,the incidence of increase in rSO2＞10％of the baseline in the pre-awakening stage was decreased(P＜0.05),no significant change was found in the incidence of decrease in rSO2＞10％of the baseline(P＞0.05),the incidence of in-crease and decrease in rSO2＞10％of the baseline throughout operation was decreased,the wake-up quality grade was increased,the wake-up time was shortened,the Ramsay sedation score was increased during the wake-up period,and the Riker agitation score was decreased,the length of stay in postanesthesia care unit and extubation time were shortened,the incidence of delirium was decreased(P＜0.05),and no significant change was found in the Visual Analogue Scale score in group Ⅰ(P＞0.05).Conclusions rSO2-oriented anesthesia management effectively regulates the balance between cerebral oxygen supply and demand,opti-mizes wake-up test and is helpful in increasing the anesthesia emergence quality.
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