Evaluation of Cognitive Functions by Cerebral Pulse Oximetry

Study Overview
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Brief Summary
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General and Spinal Anesthesia can be used in geriatric patients in orthopedic surgery. Post-op cognitive dysfunction can be seen in orthopedic surgeries in this group of patients. In this study, the investigators aimed to compare cognitive functions between spinal and general anesthesia using cerebral and systemic oxygenation, hemodynamic data and pre-op, post-op cognitive function tests.

Detailed Description
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Cerebral Oximeter is a monitoring application based on the measurement of regional oxygen saturation by transcutaneous route by near infrared spectroscopy technology. With this system that analyzes the intraparenchymal and microcirculation in the frontal cortex, cerebral oxygenation changes caused by possible hypoxemia are followed. Unlike pulse oximeter, it works in non-pulsatile conditions. In other words, continuous, real-time and safe oxygen saturation is continued to be measured even in the case of cardiopulmonary arrest. It is a significant advantage of noninvasive measurement according to jugular venous oxygen saturation measurement. For normal healthy people, the accepted normal range is 58-82%, while 0 to 15% of measurements are important for providing CPR process information. Oxygen saturation measured by cerebral oximetry is different from that measured by other oxygen saturation measurement techniques. The main reason for this is the technique itself and the region where it is used. The radiation emitted by the cerebral oximetry sensor is aimed at the microvessel structure with venous and arterial mix. Since the contribution of venous and arterial blood volume in this structure is between 70-75% and 30-25%, different results are obtained based on only arterial or just venous bed measurements. In this sense, the measured saturation value is lower than the arterial oxygen and pulse oximetry saturation values; higher than venous values. The ratio of oxyhemoglobin to the total hemoglobin below the region under evaluation of the system is expressed as, value in% System and reflected to the user as Regional Oxygen Saturation (rSO2). There are publications that can be used not only for cerebral but also for different tissues (ischemic limb, kidney, etc.). General and Spinal Anesthesia can be used in geriatric patients in orthopedic surgery. Post-op cognitive dysfunction may be seen in orthopedic surgery in this patient group. There are not enough studies showing the correlation of cognitive functions with cerebral pulse oximetry after general and spinal anesthesia. In this study, the investigators aimed to compare cognitive functions between spinal and general anesthesia using cerebral and systemic oxygenation, hemodynamic data and pre-op, post-op cognitive function tests.

Official Title
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Evaluation of Cognitive Functions by Cerebral Pulse Oximetry After General Anesthesia and Spinal Anesthesia in Geriatric Patients With Orthopedic Surgery

Conditions
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Anesthesia, Cognitive Dysfunction

Intervention / Treatment
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* Other: cerebral pulse oximetry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA 1-2 patients with lower extremity surgery Cognitive functions sufficient Exclusion Criteria: Brain functions affected Peri-operative MAP <60 ones Those with electrolyte dysfunctions Those who need more blood and blood transfusion Patients with ASA 3 and above

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Spinal anesthesia<br>Evaluation of cognitive functions of patients under 65 years of age with lower extremity surgery by cerebral pulse oximetry | Other: cerebral pulse oximetry<br>* Cognitive Functions by Cerebral Pulse Oximetry After General Anesthesia and Spinal Anesthesia<br>* Other names: postoperative cognitive dysfunctions;|
| General anesthesia<br>Evaluation of cognitive functions of patients under 65 years of age with lower extremity surgery by cerebral pulse oximetry | Other: cerebral pulse oximetry<br>* Cognitive Functions by Cerebral Pulse Oximetry After General Anesthesia and Spinal Anesthesia<br>* Other names: postoperative cognitive dysfunctions;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mini-mental testing | pre-op and post-op mini-mental testing | preoperative and postoperative 48 hours mini-mental test change | 
| cerebral pulse oxymetry value | peroperative cerebral pulse oxymetry value | change in peroperative cerebral pulse oxymetry value | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| peripheral oxygen saturation | peripheral oxygen saturation | 1 min before induction, 1 min after induction or sedation, at surgical incision, 15 min of surgery, 30 min of surgery, 45 min of surgery, 60 min of surgery, leaving the operation room, at recovery and post-op 48 hours | 
| Heart rate | Heart rate | 1 min before induction, 1 min after induction or sedation, at surgical incision, 15 min of surgery, 30 min of surgery, 45 min of surgery, 60 min of surgery, leaving the operation room, at recovery and post-op 48 hours | 
| systolic blood pressure | systolic blood pressure | 1 min before induction, 1 min after induction or sedation, at surgical incision, 15 min of surgery, 30 min of surgery, 45 min of surgery, 60 min of surgery, leaving the operation room, at recovery and post-op 48 hours | 
| diastolic blood pressure | diastolic blood pressure | 1 min before induction, 1 min after induction or sedation, at surgical incision, 15 min of surgery, 30 min of surgery, 45 min of surgery, 60 min of surgery, leaving the operation room, at recovery and post-op 48 hours | 
| hemoglobin value | hemoglobin value | before 24 hours and after 24 hours of surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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spinal and general anesthesia, cerebral pulse oxymetry, cognitive dysfunction