Effects of permissive hypercapnia combined with stellate ganglion block on cerebral oxygen saturation and postop-erative cognitive function in patients with shoulder arthroscopic surgery in beach chair position

PENG Wen-yong; CHAI Hua; ZHU Dan-yan; JIANG Xiao-feng; XU Duo-jia

doi:10.13820/j.cnki.gdyx.20241392

Abstract：Objective To investigate the effects of permissive hypercapnia combined with stellate ganglion block on hemodynamics,cerebral oxygen saturation,and postoperative cognitive function in elderly patients undergoing shoulder arthroscopy in the beach chair position.Methods A total of 120 elderly patients scheduled for shoulder arthroscopy in the beach chair position between January 2021 and June 2022 were randomly divided into three groups(40 patients each):control group(C),hypercapnia group(H),and hypercapnia combined with stellate ganglion block group(S).Heart rate(HR),mean arterial pressure(MAP),and regional cerebral oxygen saturation(rSO2)were recorded at vari-ous time points:before anesthesia(T0),immediately after intubation(T1),5 min after positioning to beach chair posi-tion(T2),and 5 min(T3),30 min(T4),1 h(T5)after adjusting the ventilator(PETCO2 maintained at 35-40 mmHg for C group and 45-50 mmHg for H and S groups;MAP maintained at 60-65 mmHg),as well as 5 min after returning to the supine position(T6)and immediately after extubation(T7).Serum β-amyloid protein-42(A β-42)and Tau protein levels were measured at T0,postoperative day 1(T8),and day 3(T9).The Mini-Mental State Examination(MMSE)was used at T8 and T9 to assess cognitive function.The incidence of cerebral desaturation events(CDE)and other adverse events were also recorded.Results Intraoperative hemodynamics were more stable in group S.rSO2 values at T3-T6 were higher in groups H and S than in group C,and group S showed significantly higher rSO2 at T1 than group C(P＜0.05).Compared with group C,groups H and S had significantly lower serum Aβ-42 and Tau protein levels at T8 and T9,with the lowest levels observed in group S(P＜0.05).MMSE scores at T8 and T9 were significantly lower than T0 across all groups(P＜0.05),but scores in groups S and H were higher than those in group C at T8(P＜0.05).The incidence of CDE was significantly lower in group S compared to groups C and H(P＜0.05),while the rates of nau-sea,vomiting,hypotension,bradycardia,or tachycardia did not differ significantly(P＞0.05).Conclusion Permissive hypercapnia combined with stellate ganglion block in elderly patients undergoing shoulder arthroscopy in the beach chair position can stabilize hemodynamics,enhance cerebral oxygen saturation,maintain stable serum Aβ-42 and Tau protein levels,and improve early postoperative cognitive function scores.