Ciprofol, Propofol and Sevoflurane for Postoperative Delirium in Elderly Brain Tumor Patients

Delirium is diagnosed using the Confusion Assessment Method (CAM). A positive CAM assessment requires the simultaneous presence of Feature 1 (acute onset and fluctuating course) and Feature 2 (inattention), plus either Feature 3 (disorganized thinking) or Feature 4 (altered level of consciousness). The outcome is reported as the proportion of participants with at least one positive CAM assessment during the 7-day postoperative period.

Duration is defined as the time interval from the first positive CAM diagnosis of delirium to the first assessment showing no delirium symptoms (CAM negative) for a continuous period of at least 24 hours. Recorded in days. If delirium persists beyond 7 days, the maximum recorded duration is 7 days.

The CAM-Severity scale quantifies delirium severity based on CAM features. The 4-item version ranges from 0 to 7 points; the 10-item version ranges from 0 to 19 points. Higher scores indicate more severe delirium. The mean daily score is calculated by averaging all CAM-S scores obtained during each calendar day.

The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. A score of 18 or above indicates normal cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.

The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.

The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.

The Telephone Montreal Cognitive Assessment (T-MoCA) evaluates cognitive function including attention, memory, language, and orientation. Total scores range from 0 to 22 points, with higher scores indicating better cognitive function. Change from baseline is calculated as the post-treatment score minus the baseline score; a positive change indicates improvement and a negative change indicates decline.

The 15-item Quality of Recovery scale (QoR-15) assesses physical and psychological recovery after surgery. Each item is scored from 0 (never able to achieve the state) to 10 (always able to achieve the state), with a total score range of 0 to 150. Higher scores indicate better quality of recovery. Change from baseline is calculated as the post-treatment score minus the baseline score.

The 15-item Quality of Recovery scale (QoR-15) assesses physical and psychological recovery after surgery. Each item is scored from 0 (never able to achieve the state) to 10 (always able to achieve the state), with a total score range of 0 to 150. Higher scores indicate better quality of recovery. Change from baseline is calculated as the post-treatment score minus the baseline score.

The Richmond Agitation-Sedation Scale (RASS) assesses the level of consciousness and agitation in the post-anesthesia care unit (PACU). Scores range from -5 (unarousable) to +4 (combative), with 0 indicating alert and calm. Higher positive scores indicate greater agitation; more negative scores indicate deeper sedation. The maximum RASS score is defined as the highest score observed across all serial assessments from admission to the PACU until discharge. A higher maximum score indicates more severe postoperative agitation.

Time from the start of anesthetic drug administration to loss of eyelash reflex and unresponsiveness to verbal command, indicating successful anesthesia induction.

Time from cessation of all anesthetic agents to eye opening in response to verbal command or spontaneous movement, indicating recovery of consciousness.

Time from cessation of all anesthetic agents to removal of the endotracheal tube after the return of adequate spontaneous breathing, airway reflexes, and consciousness.

Time from admission to the post-anesthesia care unit (PACU) to meeting discharge criteria (Steward recovery score ≥ 4) and transfer to the ward.

Mean arterial pressure (MAP) is measured continuously via invasive arterial monitoring. Baseline MAP is obtained before anesthesia induction with the participant at rest. Change from baseline is calculated as the value at each intraoperative time point minus the baseline value. Negative values indicate a decrease from baseline; positive values indicate an increase.

Heart rate (HR) is measured continuously via electrocardiogram monitoring. Baseline HR is obtained before anesthesia induction with the participant at rest. Change from baseline is calculated as the value at each intraoperative time point minus the baseline value. Negative values indicate a decrease from baseline; positive values indicate an increase.

Serum SOD is measured by standardized laboratory assay as a marker of oxidative stress. Change from baseline is calculated as the postoperative concentration minus the preoperative concentration. Higher levels indicate greater antioxidant capacity.

Serum IL-6 is measured by standardized laboratory assay as a marker of inflammation. Change from baseline is calculated as the postoperative concentration minus the preoperative concentration. Higher levels indicate greater inflammatory response.

Serum S100β is measured by standardized laboratory assay as a marker of glial cell injury and blood-brain barrier disruption. Change from baseline is calculated as the postoperative concentration minus the preoperative concentration. Higher levels indicate greater central nervous system injury.