Anesthesia, Postoperative Cognitive Dysfunction
Conditions
Brief summary
Patients receiving beach chair position shoulder surgery are vulnerable to perioperative cerebral desaturation, which is reported to be a risk factor for postoperative cognitive dysfunction. Investigators design this study to test the efficacy of perioperative goal-directed therapy in preventing cerebral desaturation and postoperative cognitive dysfunction in patients receiving beach chair position shoulder surgery.
Interventions
PROCEDUREGoal-directed fluid therapy
Patients in the group will follow our mini-fluid challenge test goal-directed therapy protocol, maintaining: * individualized optimised stroke volume by mini-fluid challenge first * keep mean arterial pressure ≧65 mmHg * keep systolic blood pressure ≦140 mmHg * keep cardiac index ≧ 2.5 L/min/cm2
PROCEDURENon goal-directed fluid therapy
Patients in the group will receive standard perioperative care at the discretion of care-giving anesthesiologist, maintaining: * keep mean arterial pressure ≧65 mmHg * keep systolic blood pressure ≦140 mmHg
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients receiving scheduled beach chair position shoulder surgery
Exclusion criteria
* pregnant women * patients in intensive care units * patients with respiratory failure \[forced expiratory volume at one second (FEV1)/ forced vital capacity (FVC) \< 70 % and FEV1 \< 50%\] * patients with heart failure(NYHA score =III、IV) * patients with chronic kidney disease (eGFR\< 60 ml.min-1.1.73m-2) * patients with liver failure * patients with ongoing infection * patients allergic to voluven
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| duration of cerebral desaturation events | 3 hours | patients will be monitored with bilateral cerebral oxymetry, and investigators will compare the duration of cerebral desaturation events |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| incidence of cerebral desaturation events | 3 hours | patients will be monitored with bilateral cerebral oxymetry, and investigators will compare the incidence of cerebral desaturation events |
| postoperative cognitive dysfunction assessed by the Taiwan version of questionnaire Qmci | 3 days | Qmci is a screening assessment developed to detect mild cognitive impairment. It's a 100-point test administered in approximately 10 minutes. A score of 60 or over is considered to be normal. The validity of the Taiwan version of Qmci has been established. |
Countries
Taiwan
Outcome results
None listed