The Role of Cerebral Oximetry in Predicting and Preventing Postoperative Cognitive Dysfunction

Abstract

Postoperative Cognitive Dysfunction (POCD) is a serious problem that is frequently seen especially in elderly patients and can cause permanent cognitive decline, prolonged hospital stay, loss of independence, decreased quality of life and even mortality. Identifying individuals at risk of developing POCD can prevent this condition by enabling the development of early interventions. POCD has a multifactorial etiology, and intraoperative cerebral perfusion disorder is considered to be one of these mechanisms. Near-infrared Spectroscopy (NIRS) device provides monitoring of regional brain oxygenation. There are studies on the predictability and preventability of cognitive disorders that may develop after surgery with the use of NIRS. In this article, it is aimed to present the study results and inferences regarding the relationships between the areas of use of NIRS and the pathogenesis of POCD.

Keywords

• postoperative neurocognitive disoders
• spectroscopy
• near-infrared
• regional cerebral oxygen saturation (rScO2)
• NIRS-based clinical algorithm

References

1. 1. Ferrari M, Mottola L, Quaresima V. Principles, techniques, and limitations of near infrared spectroscopy. Can J Appl Physiol. 2004; 29(4):463-87.
2. 2. Marin T, Moore J. Understanding near-infrared spectroscopy. Adv Neonatal Care. 2011; 11(6):382-88.
3. 3. Sabuncu U, Özgök A. Serebral oksijen satürasyonu monitörizasyonunun rejyonel doku hipoksisini tespit etmedeki yeri. GKDA Derg. 2016; 22(3):125-27.
4. 4. Hogue CW, Levine A, Hudson A, Lewis C. Clinical Applications of Near-infrared Spectroscopy Monitoring in Cardiovascular Surgery. Anesthesiology. 2021; 134(5):784-91.
5. 5. Maillard J, Sologashvili T, Diaper J, Licker MJ, Keli Barcelos G. A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest. Am J Case Rep. 2019; 20:21-25.
6. 6. Ghosh A, Elwell C, Smith M. Review article: cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg. 2012; 115(6):1373-83.
7. 7. Maillard J, Sologashvili T, Diaper J, Licker MJ, Keli Barcelos G. A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest. Am J Case Rep. 2019; 20:21-25.
8. 8. Milne B, Gilbey T, Gautel L, Kunst G. Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth. 2022; 36(7):2098-13.

9. 9. Peacock SH, Tomlinson AD. Multimodal Neuromonitoring in Neurocritical Care. AACN Adv Crit Care. 2018; 29(2):183-94.
10. 10. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119-125.
11. 11. Safavynia SA, Goldstein PA. The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving From Hypothesis to Treatment. Front Psychiatry. 2019; 9:752.
12. 12. Kapoor I, Prabhakar H, Mahajan C. Postoperative Cognitive Dysfunction. Indian J Crit Care Med. 2019; 23(Suppl 2):S162-S164.
13. 13. Pappa M, Theodosiadis N, Tsounis A, Sarafis P. Pathogenesis and treatment of post-operative cognitive dysfunction. Electron Physician. 2017; 9(2):3768-75.
14. 14. Van Sinderen K, Schwarte LA, Schober P. Diagnostic Criteria of Postoperative Cognitive Dysfunction: A Focused Systematic Review. Anesthesiol Res Pract. 2020; 2020:7384394.
15. 15. Lin X, Chen Y, Zhang P, Chen G, Zhou Y, Yu X. The potential mechanism of postoperative cognitive dysfunction in older people. Exp Gerontol. 2020; 130:110791.
16. 16. Gong GL, Liu B, Wu JX, Li JY, Shu BQ, You ZJ. Postoperative Cognitive Dysfunction Induced by Different Surgical Methods and Its Risk Factors. Am Surg. 2018; 84(9):1531-37.
17. 17. Wang R, Wang G, Liu Y, Zhang M. Preoperative smoking history is associated with decreased risk of early postoperative cognitive dysfunction in patients of advanced age after noncardiac surgery: a prospective observational cohort study. J Int Med Res. 2019; 47(2):689-701.
18. 18. Tian LJ, Yuan S, Zhou CH, Yan FX. The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022; 8:814313.
19. 19. Tang L, Kazan R, Taddei R, Zaouter C, Cyr S, Hemmerling TM. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth. 2012; 108(4):623-29.
20. 20. Holmgaard F, Vedel AG, Rasmussen LS, Paulson OB, Nilsson JC, Ravn HB. The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial. Br J Anaesth. 2019; 123(2):196-205.
21. 21. Chen N, Lu J. Meta-Analysis of the Correlation between Postoperative Cognitive Dysfunction and Intraoperative Cerebral Oxygen Saturation. Comput Math Methods Med. 2022; 2022:3731959.
22. 22. Murniece S, Soehle M, Vanags I, Mamaja B. Near Infrared Spectroscopy Based Clinical Algorithm Applicability During Spinal Neurosurgery and Postoperative Cognitive Disturbances. Medicina (Kaunas). 2019; 55(5):179.
23. 23. Ding X, Zha T, Abudurousuli G, et al. Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis. BMC Geriatr. 2023; 23(1):123.
24. 24. Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R: Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev. 2018; 1:CD010947
25. 25. Serraino GF, Murphy GJ. Effects of cerebral near-infrared spectroscopy on the outcome of patients undergoing cardiac surgery: a systematic review of randomised trials. BMJ Open. 2017; 7(9):e016613.