Correlation of anesthesia methods with serum melatonin mass concentration and delirium during recovery in elderly patients undergoing knee arthroplasty

doi:10.3969/j.issn.2095-4344.1467

Abstract

Abstract:

BACKGROUND: The incidence of postoperative delirium in senile patients is high, and the mechanism is still unclear. To study the mechanism and try to reduce the occurrence of postoperative delirium in senile patients is an important problem for anesthesiologists to solve.

OBJECTIVE: To investigate the relationship between serum melatonin concentration and delirium in recovery stage in elderly patients undergoing knee arthroplasty, and to compare the effects of different anesthesia on serum melatonin concentration.

METHODS: Patients undergoing knee replacement were randomly divided into two groups: general anesthesia group and general anesthesia + femoral nerve block anesthesia group. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The serum concentration of melatonin was measured before and at the end of operation when all anesthetic drugs were infused. The occurrence of recovery delirium was evaluated according to the nursing delirium screening scale immediately after removal of the larynx mask.

RESULTS AND CONCLUSION: (1) There was no significant difference in the incidence of delirium between general anesthesia + femoral nerve block anesthesia group and general anesthesia group (P > 0.05), but the score of delirium in general anesthesia + femoral nerve block anesthesia group was significantly lower than that in general anesthesia group (P < 0.05). (2) There was no significant difference in melatonin mass concentration between pre-and post-operation in general anesthesia + femoral nerve block anesthesia group (P > 0.05). Melatonin mass concentration was significantly decreased after operation compared with that before operation in the general anesthesia group (P < 0.05). (3) Difference of melatonin mass concentration was significantly less in the general anesthesia + femoral nerve block anesthesia group than in the general anesthesia group before and after operation (P < 0.05). (4) Spearman correlation analysis demonstrated that there was a negative correlation between delirium score during recovery stage and postoperative melatonin mass concentration (r=-0.429, P < 0.05). There was a positive correlation between delirium score during recovery stage and the difference of melatonin mass concentration (r=0.741, P < 0.05). (5) General anesthesia combined with femoral nerve block anesthesia could remarkably decrease delirium score during recovery stage in elderly patients undergoing knee arthroplasty. The mechanism may be related to inhibition of the reduction of serum melatonin mass concentration.

Key words: knee arthroplasty, delirium in recovery stage, melatonin, general anesthesia, femoral nerve block, anesthesia method

CLC Number:

R459.9|R687|R318

Jiao Yuxia, Zhou Qun, Fan Kaile, Li Dongbai. Correlation of anesthesia methods with serum melatonin mass concentration and delirium during recovery in elderly patients undergoing knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4468-4473.

Figures/Tables 6

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