Effects of Intermittent Positive Pressure Ventilation with Supreme Laryngeal Mask Airway on Cerebral Oxygen Metabolism and Postoperative Cognitive Function in Elderly Patients
SHI Tianwu, HE Wensheng, JIANG Wei, ZHANG Jun, LI Xia, HU Yuan, SUN Yunyun
Department of Anesthesiology, the Second People's Hospital of Hefei, Hefei 230011, Anhui, China
Abstract: ObjectiveTo investigate the effect of intermittent positive pressure ventilation（IPPV） with supreme laryngeal mask airway on cerebral oxygen metabolism and postoperative cognitive function in elderly patients.MethodsAdopting the method of random number table, fifty old patients with ASA Ⅰto Ⅲ, aged from 65 to 85 years old, undergoing selective limbs and lower abdominal surgery under general anesthesia, were equally randomized into 2 groups: group S was placed supreme laryngeal mask airway and group E was performed endotracheal intubation. Blood samples were taken from the radial artery and internal jugular vein bulb for blood gas analyses before tracheal intubation or Supreme laryngeal mask airway insertion (T0) and at 30 min (T1) and 60 min (T2 ) after IPPV. Cerebral arteriojugular difference of oxygen(DajvO2) and cerebral oxygen extraction rate (CERO2) were calculated. Cognitive function was assessed by MiniMental State Examination (MMSE) 1 day before operation and 24h, 48h, 1 week and 2 weeks after the operation, and the incidence of postoperative cognitive dysfunction was calculated.ResultsCompared with T0, The jugular venous oxygen saturation(SjvO2) was significantly decreased and DajvO2 and CERO2 were increased at T1and T2 in group S (P<0.05). Compared with 1 day before operation, MMSE score was significantly decreased at 24h, 48h and 1 week after operation in both groups (P<0.05). At T1 and T2, SjvO2 was lower, and DajvO2 and CERO2 were higher in group S than those in group E, and the differences were statistically (P<0.05). There was no statistical difference in MMSE score and the incidence of postoperative cognitive dysfunction at each time point between the two groups (P>0.05).ConclusionsIntermittent positive pressure ventilation with Supreme laryngeal mask airway can increase the cerebral oxygen metabolism rate during operation in elderly patients, and does not increase the incidence of postoperative cognitive dysfunction. This kind of change is in a normal range, and will not lead to anoxia of brain tissue.
史天伍，何文胜，姜维，张军，李侠，胡远，孙云云. Supreme喉罩间歇正压机械通气对老年患者脑氧代谢及术后认知功能的影响[J]. 中国现代手术学杂志, 2018, 22(3): 231-235.
SHI Tianwu, HE Wensheng, JIANG Wei, ZHANG Jun, LI Xia, HU Yuan, SUN Yunyun. Effects of Intermittent Positive Pressure Ventilation with Supreme Laryngeal Mask Airway on Cerebral Oxygen Metabolism and Postoperative Cognitive Function in Elderly Patients. Chinese Journal of Modern Operative Surgery, 2018, 22(3): 231-235.
Aydogmus MT, Turk HS, Oba S, et al. Can SupremeTM laryngeal mask airway be an alternative to endotracheal intubation in laparoscopic surgery?［J］. Braz J Anesthesiol, 2014, 64(1):6670. doi: 10.1016/j.bjane.2012.12.008.
［2］
Yao WY, Li SY, Sng BL, et al. The LMA SupremeTM in 700 parturients undergoing cesarean delivery: an observational study［J］. Can J Anaesth, 2012, 59(7):648654. doi: 10.1007/s1263001297184.
［3］
Kang F, Li J, Chai X, et al. Comparison of the Igel laryngeal mask airway with the LMAsupreme for airway management in patients undergoing elective lumbar vertebral surgery［J］. J Neurosurg Anesthesiol, 2015, 27(1):3741. doi: 10.1097/ANA.0000000000000088.
Colbert SA, O'Hanlon DM, Flanagan F, et al. The laryngeal mask airway reduces blood flow in the common carotid artery bulb［J］. Can J Anaesth, 1998, 45(1):2327.
Wei C, Yu Y, Chen Y, et al. Impact of warming blood transfusion and infusion toward cerebral oxygen metabolism and cognitive recovery in the perioperative period of elderly knee replacement［J］. J Orthop Surg Res, 2014, 9:8. doi: 10.1186/1749799X98.
Mishra SK, Nawaz M, Satyapraksh MV, et al. Influence of head and neck position on oropharyngeal leak pressure and cuff position with the Proseal laryngeal mask airway and the IGel: A randomized clinical trial［J］. Anesthesiol Res Pract, 2015:705869. doi: 10.1155/2015/705869.
Yu W. Anesthesia with propofol and sevoflurane on postoperative cognitive function of elderly patients undergoing general thoracic surgery［J］. Pak J Pharm Sci, 2017, 30(3(Special)):11071110.
Anthony JC, LeResche L, Niaz U, et al. Limits of the 'MiniMental State' as a screening test for dementia and delirium among hospital patients［J］. Psychol Med, 1982, 12(2):397408.
2018, Vol. 22 
