Postoperative cognitive dysfunction (POCD)is a common well disorder of the central nervous system after surgery, mainly manifested by impaired memory, spirit, language ability or other aspects of brain function. POCD, which often occurs in elderly patients over 65 years, The recent phase is recommended to be changed to perioperative neurocognitive impairment ( PND), The PND is used to describe the cognitive function changes that occur before and within 1 year after surgery, Based on the time of disease onset, It can be divided into neurocognitive impairment existing before surgery, postoperative delusion (POD) occurring hours to days after surgery, neurocognitive recovery delay (DNR) within 30 days after surgery, and postoperative neurocognitive impairment occurring weeks to months after surgery (POND). With the acceleration of the aging process of Chinese social population, the frequency of surgical treatment for elderly inpatients has also increased, and the elderly patients have postoperative sleep disorders, and POCD is relatively common. Surgical patients after surgical trauma, the body inflammation, sympathetic excitation and endocrine disorders, make postoperative sleep structure or pattern change, often lead to postoperative sleep disorders (PSD) , the main performance for patients with postoperative complaint difficult to enter and maintain sleep, frequent nightmares, total sleep quantity and quality reduction, etc. PSD is not only the most common manifestation of postoperative brain dysfunction, but also an important risk factor for inducing postoperative fatigue, postoperative hyperalgesia, metabolic dysfunction, and cardiovascular and cerebrovascular diseases. Moreover, it is considered to promote the development of postoperative delusion. At present, the common mode of general anesthesia is still mainly opioids, and opioids are an important part of general anesthesia and perioperative analgesia. Perioperative use of opioids is not only associated with adverse effects such as postoperative nausea and vomiting, excessive sedation, and ileus, but also leads to the occurrence of postoperative hypoxemia, hyperalgesia and postoperative chronic pain, and cognitive impairment. Therefore, the Association of Accelerated Rehabilitation Surgery indicates that the use of a multimodal analgesic regimen during the perioperative period reduces pain and reduces opioid-related adverse effects, and that opioid-free anesthesia ( OFA) is used in clinical work. At present, most clinical studies of OFA focus on adults aged 18-65 or 18 years old, and few studies focus OFA solely on the elderly population to observe its application effect. Therefore, it is necessary to conduct clinical studies to observe postoperative recovery in elderly patients with different types of anesthetics, investigate the incidence and severity of POCD, and determine the efficacy and safety of each anesthetic agent.
Elderly patients to undergo elective non-cardiac surgery
ASA grade I or III;
volunteered in this trial and signed informed consent;
age 60 years;
Chronic pain;
severe liver dysfunction (total bilirubin 2 mg dl-1);
severe renal dysfunction (glomerular filtration rate 60ml min-1 1.73m-2);
preoperative heart rate <50 beats / min, sick sinus syndrome, severe heart block;
Parallel
Opioid-free Analgesics
Drugopioid free group: After infusion of a loading dose of dexmedetomidine, intravenous midazolam 2mg, propofol 2mg kg-1, esketamine 0.5 mg kg-1, rocuronium 0.6-1mg kg-1, and 3min after endotracheal intubation. Intravenous continuous infusion of propofol, esketamine and dexmedetomidine hydrochloride mixture (esketamine 50mg + dexmedetomidine hydrochloride 150 ug + 0.9% saline 50ml in the same 50ml syringe) 0.1ml kg-1 h-1-0.2 ml kg-1 h-1 (equivalent to esketamine 0.1-0.2mg kg-1 h-1; Dexmedetomidine hydrochloride 0.3-0.6 μ g kg-1 h-1) maintains a BIS value between 40-60, 10-20mg / time was added as appropriate.
Opioid group
DrugIntravenous midazolam 2mg, propofol 2mg kg-1, sufentanyl 0.3-0.5 μ g kg-1, rocuronium 0.6-1mg kg-1,3min before endotracheal intubation. After successful endotracheal intubation, continuous intravenous infusion of propofol and remifentanil was started to maintain BIS values between 40-60, and rocuronium 10-20mg / time as appropriate. After the start of surgery, 10-20 μ g of sufentanil was added according to blood pressure and heart rate. At the end of the operation, 5mg and 50mg were injected before the end of the operation, and propofol and remifentanil were stopped at the end of the operation
15-item recovery quality scale score 24 hours before surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
15-item recovery quality scale score 24 hours after surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
15-item recovery quality scale score 48 hours after surgery
The QoR-15 scale is a global measure of postoperative recovery, with scores ranging from 0 (extremely poor QoR) to 150 (excellent QoR). QoR-15 has become the most widely reported indicator for the evaluation of postoperative life treatment in patients. Using wherever possible QoR-15 item scores on postoperative day 3, QoR-15 with very good validity, and good reliability, responsiveness and clinical acceptability, these data suggest that QoR-15 is an excellent patient-centered measure of postoperative QoR. Patient Acceptable symptom status describes the lowest absolute score considered by the patient to represent a healthy or good status health scale. A QoR-15 score of 118 or more indicates a good postoperative recovery
Pittsburgh Sleep Quality Index，PSQI
The PSQI scale consists of seven aspects, including time to sleep, hypnotic drugs, sleep time, daytime dysfunction, sleep quality, sleep efficiency, and sleep disorders, with a total score of 0 to 21, which is generally considered in China Score 7 means the presence of sleep disturbance, the higher the score indicates more severe sleep disturbance\]; due to PSQI The simplicity of the scale has good reliability and validity, and the results of polysomnography and EEG exist larger Guan Xing, which has become the most widely used scale in sleep research at home and abroad
Pittsburgh Sleep Quality Index，PSQI
The PSQI scale consists of seven aspects, including time to sleep, hypnotic drugs, sleep time, daytime dysfunction, sleep quality, sleep efficiency, and sleep disorders, with a total score of 0 to 21, which is generally considered in China Score 7 means the presence of sleep disturbance, the higher the score indicates more severe sleep disturbance\]; due to PSQI The simplicity of the scale has good reliability and validity, and the results of polysomnography and EEG exist larger Guan Xing, which has become the most widely used scale in sleep research at home and abroad
Pittsburgh Sleep Quality Index，PSQI
The PSQI scale consists of seven aspects, including time to sleep, hypnotic drugs, sleep time, daytime dysfunction, sleep quality, sleep efficiency, and sleep disorders, with a total score of 0 to 21, which is generally considered in China Score 7 means the presence of sleep disturbance, the higher the score indicates more severe sleep disturbance\]; due to PSQI The simplicity of the scale has good reliability and validity, and the results of polysomnography and EEG exist larger Guan Xing, which has become the most widely used scale in sleep research at home and abroad
Pittsburgh Sleep Quality Index，PSQI
The PSQI scale consists of seven aspects, including time to sleep, hypnotic drugs, sleep time, daytime dysfunction, sleep quality, sleep efficiency, and sleep disorders, with a total score of 0 to 21, which is generally considered in China Score 7 means the presence of sleep disturbance, the higher the score indicates more severe sleep disturbance\]; due to PSQI The simplicity of the scale has good reliability and validity, and the results of polysomnography and EEG exist larger Guan Xing, which has become the most widely used scale in sleep research at home and abroad
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