Permissive hypercapnia combined with goal-directed fluid therapy improve postoperative mental health in elderly patients undergoing laparoscopic surgery.

Abstract

Background: An investigation is undertaken to assess the effects of permissive hypercapnia (PH) combined with goal-directed fluid therapy (GDFT) on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.

Aim: To ascertain whether the combination of PH and GDFT improves clinical recovery indicators, reduces postoperative complications, and alleviates anxiety, depression, and inflammatory responses in this specific patient population.

Methods: A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups: A control group (n = 60) and a study group (n = 60). In the control group, conventional anesthesia ventilation and fluid management protocols were administered, while in the study group, PH (with intraoperative PaCO₂ maintained between 45-55 mmHg) was combined with GDFT. Postoperative recovery indicators, including the time to first flatus, time to ambulation, and length of hospital stay, were compared between the groups. Additionally, complication rates, anxiety-depression scores assessed via the Hospital Anxiety and Depression scale, and levels of inflammatory factors were analyzed to evaluate the outcomes.

Results: When compared with the control group, the study group demonstrated significantly shorter time to first flatus [(48.3 ± 6.2) hours vs (62.5 ± 7.8) hours], time to ambulation [(28.4 ± 4.2) hours vs (38.6 ± 5.1) hours], and length of hospital stay [(5.2 ± 1.1) days vs (7.4 ± 1.3) days] (P < 0.05). A significantly lower postoperative complication rate was observed in the study group (8.3% vs 21.7%, P < 0.05). Additionally, at 3 days postoperatively, significantly lower anxiety scores [(5.2 ± 1.4) vs (7.8 ± 1.6)] and depression scores [(4.8 ± 1.2) vs (7.1 ± 1.5)] were recorded in the study group compared to the control group (P < 0.05); Furthermore, at 24 hours postoperatively, serum levels of interleukin-6, tumor necrosis factor α, and C-reactive protein were found to be significantly lower in the study group than in the control group (P < 0.05).

Conclusion: Postoperative recovery is significantly expedited, postoperative complications are markedly reduced, anxiety-depression status is substantially improved, and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT, thereby making it worthy of clinical application.