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

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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.

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