Effect of NE Infusion on Postoperative Delirium in Elderly Patients Undergoing PFNA Internal Fixation
Abstract
Objective: To observe the effect of blood pressure management by norepinephrine infusion on postoperative delirium (POD) in elderly patients undergoing PFNA internal fixation. Methods: 80 elderly patients undergoing elective PFNA internal fixation under spinal anesthesia, aged >65 years, ASA II or III, with body mass index(BMI) of 16.9 kg/m2 to 27.8 kg/m2, were included and divided into a test group(group T) and a control group (group C) using the random number table method, with 40 cases in each group. In group T, patients received an infusion of 8μg/mL norepinephrine (NE) that was begun at 15 mL/h immediately after spinal anesthesia, and then adjusted within the range 0-30mL/h according to systolic blood pressure(SBP) values measured noninvasively at 2-minute interval until the patients left the operating room, with the goal of maintaining values from baseline to 20% above the baseline; in group C, SBP values was allowed to fluctuate ±20% baseline by giving a bolus of 8μg NE(8 µg/mL). The incidence of POD within 7 days after surgery was recorded. SBP values, SpO2, and HR were recorded at the following endpoints: before the induction of anesthesia (T1),4 minutes after anesthesia (T2), before incision (T3), 4 minutes, 10 minutes, 20 minutes after incision (T4-6), at the end of surgery (T7), 5 minutes before leaving the room (T8).NE amount and occurrence of adverse events were recorded. Results: Compared with group C, the incidence of POD was reduced, SBP values at T2 to T8 and NE amount was increased (P<0.05). Conclusion: Infusion of 8µg/mL of NE maintaining SBP values from baseline to 20% above the baseline reduces the incidence of POD in elderly patients undergoing PFNA internal fixation.
References
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