Anesthetic management
delirium, attentional disturbance, perceptual impairment, intraoperative blood loss, disorientation, memory disturbance, psychomotor retardation, pain
EVENTS, INTRAOPERATIVE BLOOD LOSS
The evening prior to surgery, MMSE cognitive test and weight measurement were performed. Patients with preoperative pain took tramadol hydrochloride sustained -release tablets for symptomatic relief. After the patient entered the operating room, the anesthesiologist assistant opened a sequentially numbered, sealed, opaque envelope containing the patient’s assignment. Patients were continuously monitored for invasive blood pressure, pulse oxygen saturation, electrocardiogram, bispectral index (BIS), and local cerebral oxygen saturation (rSOTo minimize intraoperative blood loss, the patient’s mean arterial pressure was controlled at about 60–65 mmHg by inhalation of sevoflurane, or by intravenous infusion of esmolol or nitroglycerin, while the oxygen supply to vital organs was ensured. If the mean arterial pressure falls below 60 mmHg during surgery, dopamine or norepinephrine is given. Intraoperative cerebral desaturation events (CDEs) were recorded (rSOThe CAM-CR score includes: acute onset, attentional disturbance, disturbed thinking, altered level of awareness, disorientation, memory disturbance, perceptual impairment, psychomotor arousal, psychomotor retardation, fluctuation, and alteration of sleep–wake cycle in a total of 11 items, and each index was scored from 1 to 4. Each index was classified according to the severity as: 1 point: none; 2 points: mild; 3 points: moderate; 4 points: severe. The total score is 11 to 44, with 22 points as the threshold for delirium, and more than 22 points were diagnosed as delirium.