Deep Neuromuscular Block on Cytokines Release and Postoperative Delirium

• Study design

• This is a prospective, randomized, single blinded study.
• Measurement values

• Neuromuscular monitoring by post-tetanic count (PTC) during operation
• Regional cerebral oxygen saturation monitoring
• Mean systemic blood pressure (MBP), heart rate (HR)
• Cardiac index (CI), using non-invasive cardiac output monitor
• IL-1ß, IL-6, TNF-α, IL-10 and CRP
• Arterial blood gas analysis (ABGA)
• Laboratory values [Hemoglobin, Hematocrit, serum albumin, creatinine, CPK, LDH]
• Postoperative pain, using visual analogue scale (VAS)
• Postoperative nausea and vomiting (PONV)
• Total infused amounts of drugs
• Total anesthesia duration, intubation duration and operation duration
• Intubation duration, operation duration
• Incidence of postoperative intensive care unit (ICU) admission
• Total ICU staying duration, if patients admit to ICU
• Preoperative and postoperative left ventricular ejection fraction change
• Incidence of hypotension (mean blood pressure lesser than 60 mmHg)
• Incidence of postoperative delirium using confusion assessment method (CAM) intensive care unit (ICU)
• Total amount of blood products transfusion (paced red blood cells, fresh frozen plasma, platelet concentration, cryoprecipitate)
• Total amount of crystalloids and colloids infusion
• Total amount urine output

Inclusion criteria

• All adult (more than 50 years old) patients scheduled for total hip arthroplasty and total knee arthroplasty who have signed the written informed consent.

Exclusion criteria

• Inability to give informed consent
• Preexisting cognitive dysfunction or delirium
• Known allergy to rocuronium sugammadex
• Underlying liver dysfunction (AST and ALT more than 100 IU/l)
• Underlying kidney dysfunction (Serum Creatinine more than 1.5 mg/dl)
• Underlying neuromuscular disease
• Patients taking any medication with potential interference with neuromuscular transmission