Effects of non-intubated spontaneous breathing on cerebral oxygen saturation and postoperative cognition in elderly patients with lung cancer undergoing video-assisted thoracoscopic surgery

JOURNAL/mgres/04.03/01612956-990000000-00064/figure1/v/2025-10-02T154314Z/r/image-tiff Video-assisted thoracoscopic surgery during one-lung ventilation may impair cerebral oxygen balance and increase the risk of postoperative cognitive impairment. This perspective study aimed to analyze the effect of non-intubated anesthesia with preserved spontaneous breathing on cerebral oxygen saturation and postoperative cognitive dysfunction in elderly patients with lung cancer during video-assisted thoracoscopic surgery. A total of 104 elderly patients with lung cancer who underwent video-assisted thoracoscopic surgery in Jinhua Municipal Central Hospital from January 2023 to October 2024 were selected, and they were randomly divided into non-intubated group (n = 52) and intubated group (n = 52). The cerebral oxygen saturation, postoperative cognitive dysfunction incidence and laboratory indicators were compared between the two groups. At last, the influencing factors to postoperative cognitive dysfunction were analyzed by multivariate Logistic regression. The cerebral oxygen saturation was higher at 15, 30 and 60 minutes after operation than at the beginning of anesthesia, and moreover, it in the non-intubation group were significantly higher than that in the intubated group (P < 0.05). At 72 hours after operation, the levels of tumor necrosis factor-α, interleukin-6 and S100β in serum were lower than those before operation, and the levels in the non-intubated group were significantly lower than those in the intubated group; the levels of epinephrine, atrial natriuretic peptide and cortisol in serum were higher than those before operation, and they in the non-intubated group were significantly more than those in the intubated group (P < 0.05). The total incidence of postoperative cognitive dysfunction in intubation group was higher than that in the non-intubated group within 2 months after operation (P < 0.05). Multivariate Logistic regression analysis showed that age (odds ratio = 1.729), cerebral oxygen saturation at 30 minutes after operation (odds ratio = 0.727) and cerebral oxygen saturation at 60 minutes after operation (odds ratio = 0.734) were independent influencing factors for postoperative cognitive dysfunction (all P < 0.05). Non-tracheal intubation anesthesia with preserved spontaneous breathing can increase cerebral oxygen saturation, reduce systemic inflammatory response and stress response, and decrease the incidence of postoperative cognitive dysfunction in elderly patients with lung cancer undergoing video-assisted thoracoscopic surgery, which is conducive to promoting postoperative recovery in such patients.