Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial
Abstract Background Neuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-12-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02340-5 |
| _version_ | 1797388132208869376 |
|---|---|
| author | Fang Xu Yanan Li Xupeng Wang Ran Sun Zilei Zheng Qi Zhang Mingyang Gao Wei Tao Juan Zhao Qiujun Wang |
| author_facet | Fang Xu Yanan Li Xupeng Wang Ran Sun Zilei Zheng Qi Zhang Mingyang Gao Wei Tao Juan Zhao Qiujun Wang |
| author_sort | Fang Xu |
| collection | DOAJ |
| description | Abstract Background Neuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its effect on neutrophil activation and inflammatory cytokine expression. Methods We studied the effect of pre-infusion of 4 mL/kg 3% hypertonic saline vs. 4 mL/kg 0.9% normal saline on POD in patients undergoing shoulder arthroscopy in a prospective, randomized, double-blind, controlled trial. Neutrophil surface molecules (CD11b, CD66b and CD64) were analyzed by flow cytometry. Circulating concentrations of inflammatory factors IL-1β, IL-6, TNF-α and neurological damage factor S100β were assessed by enzyme immunoassay. The Confusion Assessment Method-Chinese Revision (CAM-CR) was applied for the assessment of POD 1–3 days after surgery. Results The incidence of POD in group H was significantly lower than that in group N (7.14% vs 26.83%, P = 0.036). The expression levels of inflammatory cytokines ( IL-6 and TNF-α) and neutrophil surface markers (CD11b and CD66b) were significantly lower in group H than in group N at 24 h after surgery (P = 0.018, P < 0.001, P < 0.001, P = 0.024). There were no significant differences in postoperative pain, nausea and vomiting, infection, phlebitis, and patients satisfaction between the two groups. Conclusion Pre-infusion of HS can reduce the incidence of POD and the immune-inflammatory response. Trial registration Chinese Clinical Trial Registry (14/4/2022, registration number: ChiCTR2200058681. |
| first_indexed | 2024-03-08T22:35:20Z |
| format | Article |
| id | doaj.art-68abf1dfb9a34f50a5edf2d5277c3b5e |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-08T22:35:20Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-68abf1dfb9a34f50a5edf2d5277c3b5e2023-12-17T12:28:09ZengBMCBMC Anesthesiology1471-22532023-12-0123111010.1186/s12871-023-02340-5Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trialFang Xu0Yanan Li1Xupeng Wang2Ran Sun3Zilei Zheng4Qi Zhang5Mingyang Gao6Wei Tao7Juan Zhao8Qiujun Wang9Department of Anesthesiology, the Third Hospital of Hebei Medical UniversityDepartment of Anesthesiology, the Third Hospital of Hebei Medical UniversityDepartment of Anesthesiology, the Third Hospital of Hebei Medical UniversityDepartment of Joint Surgery, the Third Hospital of Hebei Medical UniversityDepartment of Anesthesiology, the Third Hospital of Hebei Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Hebei Province Affiliated to Hebei Medical UniversityDepartment of Anesthesiology, the Third Hospital of Hebei Medical UniversityDepartment of Breast Surgery, the First Affiliated Hospital of Jinzhou Medical UniversityTeaching Experiment Center, Hebei Medical UniversityDepartment of Anesthesiology, the Third Hospital of Hebei Medical UniversityAbstract Background Neuroinflammation may be a potential mechanism of postoperative delirium (POD) in geriatric patients, and hypertonic saline (HS) has immunomodulatory properties. The purpose of this study was to investigate whether HS could reduce the incidence of POD in elderly patients and its effect on neutrophil activation and inflammatory cytokine expression. Methods We studied the effect of pre-infusion of 4 mL/kg 3% hypertonic saline vs. 4 mL/kg 0.9% normal saline on POD in patients undergoing shoulder arthroscopy in a prospective, randomized, double-blind, controlled trial. Neutrophil surface molecules (CD11b, CD66b and CD64) were analyzed by flow cytometry. Circulating concentrations of inflammatory factors IL-1β, IL-6, TNF-α and neurological damage factor S100β were assessed by enzyme immunoassay. The Confusion Assessment Method-Chinese Revision (CAM-CR) was applied for the assessment of POD 1–3 days after surgery. Results The incidence of POD in group H was significantly lower than that in group N (7.14% vs 26.83%, P = 0.036). The expression levels of inflammatory cytokines ( IL-6 and TNF-α) and neutrophil surface markers (CD11b and CD66b) were significantly lower in group H than in group N at 24 h after surgery (P = 0.018, P < 0.001, P < 0.001, P = 0.024). There were no significant differences in postoperative pain, nausea and vomiting, infection, phlebitis, and patients satisfaction between the two groups. Conclusion Pre-infusion of HS can reduce the incidence of POD and the immune-inflammatory response. Trial registration Chinese Clinical Trial Registry (14/4/2022, registration number: ChiCTR2200058681.https://doi.org/10.1186/s12871-023-02340-5Postoperative deliriumNeuroinflammationHypertonic salineNeutrophilsCytokines |
| spellingShingle | Fang Xu Yanan Li Xupeng Wang Ran Sun Zilei Zheng Qi Zhang Mingyang Gao Wei Tao Juan Zhao Qiujun Wang Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial BMC Anesthesiology Postoperative delirium Neuroinflammation Hypertonic saline Neutrophils Cytokines |
| title | Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial |
| title_full | Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial |
| title_fullStr | Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial |
| title_full_unstemmed | Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial |
| title_short | Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial |
| title_sort | effect of pre infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy a randomized controlled trial |
| topic | Postoperative delirium Neuroinflammation Hypertonic saline Neutrophils Cytokines |
| url | https://doi.org/10.1186/s12871-023-02340-5 |
| work_keys_str_mv | AT fangxu effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT yananli effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT xupengwang effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT ransun effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT zileizheng effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT qizhang effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT mingyanggao effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT weitao effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT juanzhao effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial AT qiujunwang effectofpreinfusionofhypertonicsalineonpostoperativedeliriumingeriatricpatientsundergoingshoulderarthroscopyarandomizedcontrolledtrial |