Yuan L, Zhang XM, Liu N, Shi JQ, Sun XJ, Li GL, Teng JL. Permissive hypercapnia combined with goal-directed fluid therapy improve postoperative mental health in elderly patients undergoing laparoscopic surgery. World J Psychiatry 2025; 15(7): 106023 [DOI: 10.5498/wjp.v15.i7.106023]
Corresponding Author of This Article
Jin-Liang Teng, MD, Chief Physician, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Qiaoxi District, Zhangjiakou 075000, Hebei Province, China. tengjinliang@126.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jul 19, 2025; 15(7): 106023 Published online Jul 19, 2025. doi: 10.5498/wjp.v15.i7.106023
Permissive hypercapnia combined with goal-directed fluid therapy improve postoperative mental health in elderly patients undergoing laparoscopic surgery
Li Yuan, Xiao-Min Zhang, Na Liu, Jun-Qi Shi, Xiao-Jie Sun, Guo-Li Li, Jin-Liang Teng
Li Yuan, Xiao-Min Zhang, Na Liu, Jun-Qi Shi, Guo-Li Li, Jin-Liang Teng, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Xiao-Jie Sun, Intensive Care Unit, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Author contributions: Yuan L and Zhang XM contributed equally to this work and were responsible for data collection, statistical analysis, and manuscript drafting; Liu N and Shi JQ participated in patient recruitment, perioperative management, and follow-up; Sun XJ contributed to critical care data extraction and interpretation; Li GL assisted in study design and literature review; Teng JL conceived and supervised the study, revised the manuscript, and is the corresponding author and all authors read and approved the final manuscript.
Supported by the 2024 Hebei Medical Science Research Project, No. 20241638; and Key Research and Development Program of Zhangjiakou City, No. 2311041D.
Institutional review board statement: This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Hebei North University, approval No. K2024141.
Informed consent statement: Informed consent was waived by the Medical Ethics Committee of The First Affiliated Hospital of Hebei North University due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Liang Teng, MD, Chief Physician, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Qiaoxi District, Zhangjiakou 075000, Hebei Province, China. tengjinliang@126.com
Received: March 7, 2025 Revised: April 19, 2025 Accepted: June 10, 2025 Published online: July 19, 2025 Processing time: 124 Days and 20.6 Hours
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.
Core Tip: This study highlights the benefits of permissive hypercapnia (PH) combined with goal-directed fluid therapy (GDFT) in elderly patients undergoing laparoscopic surgery. The PH + GDFT strategy is demonstrated to significantly accelerate postoperative recovery, reduce complications, and alleviate anxiety and depression. Additionally, it is observed to reduce levels of inflammatory markers, enhance sleep quality, and improve overall patient satisfaction. Multivariate analysis confirms PH + GDFT as an independent protective factor against postoperative psychological distress. These findings advocate for the integration of PH and GDFT into perioperative management to optimize both physical and psychological outcomes, particularly for elderly patients. This study offers clinical evidence supporting the refinement of anesthesia and fluid management strategies in minimally invasive surgery.
