Abstract:Objective To evaluate the influences of intraoperative regional cerebral oxygen saturation (rSO₂) monitoring and goal-oriented regulation on postoperative early neurocognitive disorders in surgical treatment of adolescent idiopathic scoliosis. Methods A total of 86 adolescents aged 11-18 years old and with American Society of Anesthesiologists (ASA) class Ⅰ or Ⅱ undergoing elective surgery for scoliosis were randomly assigned into rSO₂regulation group (G group, n=43) and control group (C group, n=43). The rSO₂ value measured in a quiet state was defined as the baseline after the patients entering operating room. As rSO₂ value decreased by more than 10% of the baseline, the active measures should be immediately taken to maintain rSO₂ value at the target range (decreasing lower than 10% of the baseline), including the increases of partial pressure of end-tidal carbon dioxide, inhaled oxygen concentration and mean arterial pressure (MAP), adjusting the lateral position of the head and neck and transfusion of red blood cells in G group, and the routine anesthesia management was performed in C group. The rSO₂values were recorded before anesthesia induction (T0), 5 min after tracheal intubation (T1), 30 min after surgery for scoliosis (T2), 30 min after complete exposure of the lamina (T3), and 30 min after osteotomy (T4) and immediately before the end of the surgery (T5) in both groups. The cases of rSO₂ decreased by more than 10% and lasting for more than 5 min during operation were recorded and classified as mild group with a rSO₂ decrease of ≥10% and ＜20%, moderate group with a rSO₂ decrease of ≥20% and ＜30% and severe hypoxia group with a rSO₂ decrease ≥30% according to its reduction degree. The relevant indexes during operation and anesthesia recovery period were recorded, and the postoperative neurocognitive disorders were observed and evaluated in two groups. Results Forty patients in each group ampleted the study. Eye opening time, extubation time and retention time in post-anesthesia care unit in G group were significantly shorter than those in C group (P<0.05). The rSO₂ values at T2 and T4 were significantly lower than those at other time points in both groups (P<0.05), and they were statistically higher in G group than those in C group at T2 and T4 (P<0.05). There was no significant difference in rSO₂ values at T0, T1, T3 and T5 between two groups (P>0.05). There were 1 and 2 cases of moderate cerebral hypoxia in G group and C group, respectively. The incidence of mild cerebral hypoxia in G group was significantly lower than that in C group (P<0.05), and the percentage of normal rSO₂ value in G group was statistically higher than that in C group (P<0.05). There was no significant difference in the incidence of postoperative delirium (one case per group, P>0.05). The incidence of delayed neurocognitive recovery in G group was significantly lower than that in C group (10.0% vs 27.5%, χ²=4.02, P<0.05). Conclusion Intraoperative rSO₂ monitoring and goal-oriented regulation can effectively reduce the degree of cerebral ischemia and hypoxia during surgical treatment for adolescent scoliosis, accelerate the recovery and decrease the incidence of early postoperative neurocognitive disorders.