Correlation of Perioperative Brain Metabolites With Postoperative Delirium in Elderly Oral Craniomaxillofacial Surgery Patients

Study Overview
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Brief Summary
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In view of the increasingly severe aging situation in China, the perioperative brain health of elderly patients has received increasing attention. Postoperative delirium (POD) is a common postoperative complication characterized by acute consciousness and cognitive dysfunction. The incidence of POD in elderly patients undergoing elective non cardiac surgery is 20% 45%, which often indicates poor cognitive recovery and becomes a heavy burden for family and society. Although the weight of human brain only accounts for 2% of body weight, the oxygen consumption accounts for 20% of the total oxygen consumption of the whole body. On July 2, 2022, the British Journal of Anaesthesia (Chinese Academy of Sciences Division 1, Anesthesiology Division 1, IF11.719), the top international Journal in the field of anesthesiology, published the scientific research achievements of the first author of the applicant. It was found for the first time that sevoflurane, the most commonly used inhalation anesthetic in clinical practice, can cause the activation of glycolysis and the increase of lactic acid in the brain of elderly non-human primate marmosets, which suggests that general anesthetics will affect brain metabolism in the perioperative period. Therefore, we hypothesized that perioperative changes in brain metabolism might be related to the occurrence of POD in elderly patients. The purpose of this study was to study the relationship between the changes of brain metabolites and POD during perioperative period by noninvasive monitoring of the characteristics of brain tissue metabolites 24 hours before and 24 hours after the operation with hydrogen ion proton magnetic resonance spectroscopy (1-HMRS). In order to complete this purpose, this study plans to collect subjects aged 65 90 years who are scheduled to undergo oral and maxillofacial surgery under general anesthesia. The changes of brain metabolites before and after operation were collected by 1-HMRS, and the postoperative delirium related scale was evaluated to analyze the relationship between perioperative changes of brain metabolites and POD.

Official Title
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Correlation of Perioperative Brain Metabolites With Postoperative Delirium in Elderly Oral Craniomaxillofacial Surgery Patients

Conditions
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Delirium in Old Age

Intervention / Treatment
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* Other: Collecting clinical data, blood gas data, Magnetic Resonance Spectroscopy (MRS) data and blood,urine, and feces sample


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The ASA grade of the subject is Ⅰ - Ⅲ; 65-90 years old; Oral craniomaxillofacial surgery under combined general anesthesia Exclusion Criteria: The following medical devices have been installed in the body or are to be installed or implanted in the hospital: various cardiac pacemakers; Metal implants (non titanium), ferromagnetic vascular clips in the body The patient is left-handed; Patients with claustrophobia; People with vision and hearing impairment, illiterate or difficult to communicate; The operation plan includes patients with tracheotomy or postoperative catheterization; Refusing to sign the clinical trial consent form.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients in the control group were followed up without delirium postoperatively.<br>If the 3D-CAM scale all show a negative resluts | Other: Collecting clinical data, blood gas data, Magnetic Resonance Spectroscopy (MRS) data and blood,urine, and feces sample<br>* Collecting clinical data(before induction of anesthesia and first day after surgery), blood gas data(before induction of anesthesia and first day after surgery) ，MRS data (not more than 24h after surgery）and blood,urine, and feces sample （before induction of anesthesia and first day, third day and 7th day after surgery）<br>|
| Patients in the case group were followed up with delirium postoperatively.<br>If the 3D-CAM assessment is positive at any time point after surgery | Other: Collecting clinical data, blood gas data, Magnetic Resonance Spectroscopy (MRS) data and blood,urine, and feces sample<br>* Collecting clinical data(before induction of anesthesia and first day after surgery), blood gas data(before induction of anesthesia and first day after surgery) ，MRS data (not more than 24h after surgery）and blood,urine, and feces sample （before induction of anesthesia and first day, third day and 7th day after surgery）<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 1 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 2 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 3 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 4 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 5 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 6 day after surgery | 
| 3D-CAM (3-minute Diagnostic Interview for Confusion Assessment Method) scale | 3D-CAM higher means worse | 7 day after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MOCA(Montreal Cognitive Assessment) scale | MOCA higher means better | 1 day after surgery | 
| MOCA(Montreal Cognitive Assessment) scale | MOCA higher means better | 3 day after surgery | 
| MOCA(Montreal Cognitive Assessment) scale | MOCA higher means better | 7 day after surgery | 
| MMSE (mini-mental state examiniation) scale | MMSE higher means better | 1 day after surgery | 
| MMSE (mini-mental state examiniation) scale | MMSE higher means better | 3 day after surgery | 
| MMSE (mini-mental state examiniation) scale | MMSE higher means better | 7 day after surgery |