Trace of delirium after robotic lower abdominal tumor resection at different end-tidal carbon dioxide: a RCT trial

Abstract

Background: Postoperative delirium (POD) often occurs in oncology patients, further increasing the medical and financial burden. Robotic technology in lower abdominal tumors resection reduces surgical trauma but increases risks such as carbon dioxide (CO₂) absorption. This study aimed to investigate the differences in their occurrence of POD at different end-tidal CO₂ levels.

Method: This study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn , Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO₂ was performed depending on the randomized grouping after intubation. Group L received lower level etCO₂ management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis.

Results: Among the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO₂ groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups.

Conclusion: With robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.

Keywords: End-tidal carbon dioxide; Postoperative delirium; Robotic surgery; Tumor resection.

Fig. 1

Respiratory management process. a End-tidal carbon dioxide adjustment process for Group L. b End-tidal carbon dioxide adjustment process for Group H. Abbreviations: TV, Tidal Volume; RR, Respiratory Rate; Peak, Peak Airway Pressure, etCO2, end-tidal carbon dioxide

Fig. 2

Patients flow diagram

Fig. 3

Univariate and multivariate associations with postoperative delirium