Effect of Goal-directed Fluid Therapy on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Combined Lingual and Cervical Radical Surgery

Abstract

Background: The intraoperative rehydration technique known as the effect of Goal-Directed Fluid Therapy (GDFT), which is guided by the dynamic monitoring of volume responsiveness, has received a lot of attention recently. According to a meta-analysis by Bene, GDFT can maintain intraoperative hemodynamic stability, which lowers the incidence of postoperative complications and reduces stay at the intensive care unit. Objectives: This study aimed to determine how GDFT affected elderly patients who underwent combined lingual and cervical radical surgery after an operation for postoperative cognitive dysfunction (POCD). Methods: This interventional study was conducted between December 2021 and December 2022 in a medical center affiliated with Fujian Medical University on people undergoing radical neck and tongue surgery for tongue cancer. The samples (n=36) were selected using an availability sampling method and randomly divided into conventional fluid therapy (the Non-GDFT, n=18) and GDFT (n=18) groups. The Non-GDFT group was hydrated normally during anesthesia. A continuous infusion of 8 mL/(kg/h) of compounded sodium chloride was administered to the GDFT group to maintain basal hydration volume during the operation. Before and following surgery, Montreal Cognitive Assessment Scale scores were completed, arterial blood lactate values and bilateral cerebral oxygen saturation levels were measured at various times following the stabilization of anesthesia, and the levels of interleukin 6 (IL-6) and S100 protein in venous blood were calculated. Results: The Non-GDFT group had a higher incidence of POCD than the GDFT group, the GDFT group had significantly lower levels of IL-6 and S100 than the Non-GDFT group, the GDFT group had significantly lower levels of serum lactate than the Non-GDFT group. The GDFT group experienced significantly lower rates of intraoperative hypotensive and intraoperative low rSO2 events than the Non-GDFT group, and this difference was statistically significant (P<0.05). Conclusion: Assuring the balance of cerebral oxygen supply and demand, lowering the production of inflammatory mediators, and successfully reducing the incidence of POCD are all possible benefits of GDFT.