Study objective: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial. Design: Randomized controlled pilot trial. Setting: Perioperative care in a tertiary care teaching hospital with outpatient follow-up. Patients: One hundred one patients aged >= 75 years with ASA physical status < 4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls. Interventions: Randomization to a personalized intraoperative blood pressure target, mean arterial pressure (MAP) >= 90% of preoperative values (Target group), or to a more liberal intraoperative blood pressure management (No-Target group). Strategies to reach intraoperative blood pressure target were at discretion of anesthesiologists. Measurements: An experienced neuropsychologist performed a validated battery of neurocognitive tests preoperatively and 3 months after surgery. Incidence of POCD at three months and postoperative delirium were assessed. Intraoperative time spent with MAP >= 90% of preoperative values, recruitment and drop-out rate at 3 months were feasibility outcomes. Main results: The Target group spent a higher percentage of intraoperative time with MAP >= 90% of preoperative values (65 +/- 25% vs. 49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No correlation was found between intraoperative hypotension and postoperative cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate was of 6 patients/month (95% confidential interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusions: Intraoperative hypotension did not correlate with postoperative cognitive dysfunction or delirium occurrence in elderly patients undergoing general anesthesia for non-cardiac surgery. A multicenter randomized controlled trial is needed in order to confirm the effect of intraoperative blood pressure on the development of POCD.

Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial / T. Langer, A. Santini, F. Zadek, M. Chiodi, P. Pugni, V. Cordolcini, B. Bonanomi, F. Rosini, M. Marcucci, F. Valenza, C. Marenghi, S. Inglese, A. Pesenti, L. Gattinoni. - In: JOURNAL OF CLINICAL ANESTHESIA. - ISSN 0952-8180. - 52(2019 Feb), pp. 111-118. [10.1016/j.jclinane.2018.09.021]

Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial

T. Langer
Primo
;
F. Zadek;P. Pugni;V. Cordolcini;F. Rosini;M. Marcucci;F. Valenza;A. Pesenti
Penultimo
;
L. Gattinoni
Ultimo
2019-02

Abstract

Study objective: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial. Design: Randomized controlled pilot trial. Setting: Perioperative care in a tertiary care teaching hospital with outpatient follow-up. Patients: One hundred one patients aged >= 75 years with ASA physical status < 4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls. Interventions: Randomization to a personalized intraoperative blood pressure target, mean arterial pressure (MAP) >= 90% of preoperative values (Target group), or to a more liberal intraoperative blood pressure management (No-Target group). Strategies to reach intraoperative blood pressure target were at discretion of anesthesiologists. Measurements: An experienced neuropsychologist performed a validated battery of neurocognitive tests preoperatively and 3 months after surgery. Incidence of POCD at three months and postoperative delirium were assessed. Intraoperative time spent with MAP >= 90% of preoperative values, recruitment and drop-out rate at 3 months were feasibility outcomes. Main results: The Target group spent a higher percentage of intraoperative time with MAP >= 90% of preoperative values (65 +/- 25% vs. 49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No correlation was found between intraoperative hypotension and postoperative cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate was of 6 patients/month (95% confidential interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusions: Intraoperative hypotension did not correlate with postoperative cognitive dysfunction or delirium occurrence in elderly patients undergoing general anesthesia for non-cardiac surgery. A multicenter randomized controlled trial is needed in order to confirm the effect of intraoperative blood pressure on the development of POCD.
anesthesia, general; Blood pressure; cognitive dysfunction; Delirium; Frail elderly; anesthesiology and pain medicine
Settore MED/41 - Anestesiologia
Article (author)
File in questo prodotto:
File Dimensione Formato  
429_Langer_JClinAnesth_1-s2.0-S0952818018307748-main.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 467.69 kB
Formato Adobe PDF
467.69 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/594721
Citazioni
  • ???jsp.display-item.citation.pmc??? 18
  • Scopus 31
  • ???jsp.display-item.citation.isi??? 28
social impact