AI Article Synopsis

  • The study examined the effects of intraoperative permissive hypercapnia (high carbon dioxide levels) on plasma neurofilament light chain (NfL) concentrations in patients over 60 undergoing laparoscopic surgery.
  • A total of 84 patients were randomly placed into two groups: one maintaining normal carbon dioxide levels and the other experiencing hypercapnia.
  • Results showed no significant difference in postoperative NfL levels between the two groups, but both had increased NfL post-surgery compared to preoperative levels, and the hypercapnia group had higher area under the curve values for carbon dioxide and cerebral oxygen saturation.

Article Abstract

Background: The effects of intraoperative permissive hypercapnia (aCO of 45-55 mmHg) on the central nervous system remain unclear. Neurofilament light chain (NfL, a protein found in the axons and nerve fibers of neurons) has been associated with central nervous system disorders. This study investigated the effect of intraoperative permissive hypercapnia on plasma NfL concentration 1 day postoperatively, and in turn on the central nervous system, during laparoscopic surgery.

Methods: This investigation was a prospective, single-blind randomized controlled trial. Eighty-four individuals aged above 60 years were randomly allocated to either the normocapnia group with an aCO of 35-45 mmHg (n=42) or the hypercapnia group with a aCO of 45-55 mmHg (n=42). The primary outcome was the 1-day postoperative plasma NfL concentration. Secondary outcomes included the area under the curve (AUC) values for aCO and regional cerebral oxygen saturation (rSO). The Mann-Whitney -test was mainly used to analyze the outcomes.

Results: The final analysis included 38 and 40 patients in the normocapnia and hypercapnia groups, respectively. There was no statistically significant difference observed between the groups regarding the preoperative and 1-day postoperative plasma NfL concentration (14.0 [11.1, 19.9] vs 16.3 [9.06, 19.9] pg/mL, >0.05; 23.4 [16.8, 32.3] vs 21.5 [15.6, 29.9] pg/mL, >0.05, respectively). However, in both groups, the postoperative plasma concentration of NfL showed a significant increase when compared with the preoperative levels (both < 0.001). The AUCs of aCO and rSO from the beginning to the end of the pneumoperitoneum were significantly higher in the hypercapnia group compared with the normocapnia group (both 0.05).

Conclusion: Our results indicate that intraoperative permissive hypercapnia targeting a aCO of 45-55 mmHg does not significantly influence postoperative early plasma NfL elevation levels in elderly patients undergoing laparoscopic surgery. During general anesthesia, intraoperative permissive hypercapnia might not significantly impact the central nervous system.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576572PMC
http://dx.doi.org/10.2147/TCRM.S492456DOI Listing

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