Discussion
increase cardiac output, edema, inflammation, Hypovolemic, cognitive decline
EDEMA, INFLAMMATION, COMPLICATION, ADHESION, CYTOTOXICITY, INFLAMMATORY RESPONSE
In our study, we found that pre-infusion of HS reduced the occurrence of POD in geriatric patients after shoulder arthroscopy. The basic mechanism may be associated with the suppression of inflammatory cytokine secretion by neutrophils and improvement of cerebral perfusion. The finding that the anti-inflammatory effect of HS may be partially responsible for reducing POD confirms the neuroinflammatory hypothesis of POD.Patients under surgery and anesthesia are at higher risk of inflammatory cascade reactions and cognitive decline compared to the preoperative steady state [POD is a common complication after surgery, especially in elderly patients. POD can cause significant short-term or long-term adverse consequences, such as loss of independence, increased morbidity and mortality [On the one hand, hypertonic saline (HS) improves hemodynamics, expands intravascular volume, reduces endothelial and tissue edema, decreases blood viscosity and improves microcirculation; on the other hand, HS has multiple immunomodulatory and anti-inflammatory effects, decreases neutrophil activation, transit and cytotoxicity, and reduces the release of cytokines and chemokines in plasma [Neutrophils are the most abundant type of leukocyte in the circulation. The half-life of neutrophils under normal conditions is approximately 12 h, while inflammation and stress can extend the life span of neutrophils to 7 days [CD11b, CD66b and CD64 are neutrophil activation markers that are lowly expressed in the resting state but overexpressed in response to inflammatory stimuli, and their overexpression increases neutrophil activation, adhesion, and degranulation [During the acute phase inflammatory response, activated neutrophils secrete large amounts of cytokines and chemokines [The lack of preoperative assessment of blood volume status is a shortcoming of this study. Hypovolemic patients can be treated with fluid challenge therapy to increase cardiac output and optimize systemic tissue perfusion [