AUTHOR=Yang Shuyi , Xiao Wei , Wu Hao , Liu Yang , Feng Shuai , Lu Jie , Wang Tianlong 

TITLE=Management Based on Multimodal Brain Monitoring May Improve Functional Connectivity and Post-operative Neurocognition in Elderly Patients Undergoing Spinal Surgery

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=13

YEAR=2021

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2021.705287

DOI=10.3389/fnagi.2021.705287

ISSN=1663-4365

ABSTRACT=<p>Perioperative neurocognitive disorder (PND) is a common condition in elderly patients undergoing surgery. Sedation, analgesia, regional cerebral oxygen saturation (rSO<sub>2</sub>), and body temperature are known to be associated with PND, but few studies have examined the contribution of these factors combined in detail. This prospective, randomized, controlled, double-blinded study investigated whether anesthesia management based on multimodal brain monitoring—an anesthesia management algorithm designed by our group—could improve the post-operative cognitive function and brain functional connectivity (FC) in elderly patients undergoing elective spinal surgery with general anesthesia. The patients (aged ≥65 years) were randomized into two groups [control (Group C), <italic>n</italic> = 12 and intervention (Group I), <italic>n</italic> = 14]. Patients in Group I were managed with multimodal brain monitoring (patient state index, spectral edge frequency, analgesia nociception index, rSO<sub>2</sub>, and temperature), and those in Group C were managed with routine anesthesia management. All patients were pre- and post-operatively evaluated (7 days after surgery) with the Montreal Cognitive Assessment (MoCA). Amplitude of low-frequency fluctuation (ALFF) and FC were analyzed after resting-state functional MRI. Serum C-reactive protein (CRP) and lipopolysaccharide levels were measured, and the correlation between FC and changes in inflammatory marker levels was analyzed. Mean post-operative MoCA score was higher in Group I (24.80 ± 2.09) than in Group C (22.56 ± 2.24) (<italic>p</italic> = 0.04), with no difference in PND incidence between groups (28.57 vs. 16.67%; <italic>p</italic> = 0.47). Group I also showed significantly increased ALFF values in several brain regions after surgery (<italic>p</italic> &lt; 0.05), and FC between the left hippocampus and left orbital inferior frontal gyrus (FG), left middle FG, left superior temporal gyrus, and left precentral gyrus was enhanced (<italic>p</italic> &lt; 0.05), which was negatively correlated with the change in serum CRP (pre vs. post-intervention) (<italic>R</italic> = −0.58, <italic>p</italic> = 0.01). These results suggest that management of elderly patients undergoing surgery by multimodal brain monitoring may improve post-operative neurocognition and FC by reducing systemic inflammation.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn/index.aspx" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/index.aspx</ext-link>, identifier: ChiCTR1900028024.</p>