The effect of permissive high SVV on postoperative delirium in elderly patients in laparoscopic hepatectomy

Backgrounds: The effect of goal-directed fluid therapy (GDFT) on postoperative cognitive function in elderly patients is unknown. Therefore, we designed the present study to evaluate the effect of permissive high stroke volume variability (SVV)-mediated GDFT on postoperative delirium in elderly laparoscopic hepatectomy patients. Methods In this study, patients were randomly divided into two groups: a pilot group (group S) with SVV-guided rehydration and a control group (group C) with Central venous pressure (CVP)-guided rehydration. Group S: fluid therapy according to the target SVV value; Group C: fluid therapy according to the CVP value intraoperative parameters and postoperative outcomes were recorded for all patients. The primary outcome variables were cerebral metabolic and injury indicators, volume of access, stress and inflammatory indicators. Results Brain metabolic indexes: During operation, rSO 2%max in group S was significantly lower than that in group C (7.5% vs 12.3%), and O2ER in group S was lower than that in group C at T2-4, P < 0.05. Brain injury index: S100β protein of group C at 1 day and 3 days after surgery and NSE was significantly higher than group S, P < 0.05. The incidence of POD in group S was significantly lower than that in group C (10% VS 20%), P < 0.05. The length of hospital stay was significantly less than group C (9.3 ± 1.8 VS 12.4 ± 1.9), P < 0.05. Conclusions In laparoscopic hepatectomy in the elderly, the use of permissive high SVV during hepatectomy can ensure blood perfusion of vital organs, but also ensure less tissue bleeding, reduce cerebral oxygen metabolism, reduce the inflammatory response, and reduce the occurrence of postoperative delirium, with certain safety and feasibility.