Postoperative delirium incidence and oxidative stress in laparoscopic surgery
Authors:   Department of Anesthesia and Intensive Care, Emergency Clinical Hospital Craiova, Romania, Stanculescu Andreea D. , Iliescu Dominic G. ,   Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Craiova, Romania, Dragoescu Octavian ,   Department of Urology, University of Medicine and Pharmacy Craiova, Romania, Drocas Andrei ,   Department of Urology, University of Medicine and Pharmacy Craiova, Romania, Pirlog Mihail C. ,   Department of Medical Sociology, University of Medicine and Pharmacy Craiova, Romania, Tudorache Stefania ,   Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Craiova, Romania, Purcaru Florea ,   Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Craiova, Romania, Purnichi Traian ,   University of Medicine and Pharmacy Craiova, Romania, Dragoescu Nicoleta A. ,   Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Craiova, Romania
Published: July 2023

Postoperative delirium is a common complication of all types of surgery, especially in elderly patients (2). Overproduction of free oxygen radicals and decrease of organism defense mechanisms is believed to be involved in multiorgan failure, especially in the brain (4). It is important to determinate the susceptibility, incidence and preventive measures for postoperative delirium (8). Our objective was to identify an oxidative stress indicator that predicts the appearance of postoperative delirium in patients that undergoes laparoscopic renal or gynecological surgery for malignant diseases and the possible correlations between certain anesthetic drugs and postoperative delirium occurrence. This study included 29 patients that were treated for localized kidney or uterine cancer by trans peritoneal laparoscopic radical surgery procedures (nephrectomy or hysterectomy) between 2014 and 2016. They were randomized in two groups: the sevoflurane group (n=14 patients) and propofol group (n=15 patients). Blood samples were collected before anesthesia induction, at the end of surgery and at 24 h after surgery and the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Postoperative delirium was assessed using Confusion Assessment Method for the ICU (CAM-ICU). All patients with delirium from both groups developed the condition on the first postoperative day. In the sevoflurane group, postoperative delirium has observed in 6/14 patients (42%) and in the propofol group, 5/15 patients (33%) have developed the same postoperative syndrome. There was a significant increase of malondialdehyde levels in the delirium group compared to the non-delirium group in patients, sevoflurane and propofol, at the end of surgery. (p<0.05) There were statistical difference between delirium group and non-delirium group in both sevoflurane and propofol patients, regarding superoxide dismutase levels before anesthesia induction (p<0.05). Postoperative delirium incidence can be predicted by preoperative superoxide dismutase levels assessment in patients that undergoes laparoscopic urologic or gynecological surgery for malignant diseases.