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

Thomas Langer, Alessandro Santini, Francesco Zadek, Manuela Chiodi, Paola Pugni, Valentina Cordolcini, Barbara Bonanomi, Francesca Rosini, Maura Marcucci, Franco Valenza, Cristina Marenghi, Silvia Inglese, Antonio Pesenti, Luciano Gattinoni

Research output: Contribution to journalArticle

5 Citations (Scopus)

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. Trial registration number: NCT02428062 www.clinicaltrials.gov.

Original languageEnglish
Pages (from-to)111-118
Number of pages8
JournalJournal of Clinical Anesthesia
Volume52
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Hypotension
General Anesthesia
Delirium
Randomized Controlled Trials
Blood Pressure
Arterial Pressure
Perioperative Care
Incidence
Tertiary Healthcare
Random Allocation
Teaching Hospitals
Outpatients
Cognitive Dysfunction

Keywords

  • Anesthesia, general
  • Blood pressure
  • Cognitive dysfunction
  • Delirium
  • Frail elderly

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery : results of a randomized controlled pilot trial. / Langer, Thomas; Santini, Alessandro; Zadek, Francesco; Chiodi, Manuela; Pugni, Paola; Cordolcini, Valentina; Bonanomi, Barbara; Rosini, Francesca; Marcucci, Maura; Valenza, Franco; Marenghi, Cristina; Inglese, Silvia; Pesenti, Antonio; Gattinoni, Luciano.

In: Journal of Clinical Anesthesia, Vol. 52, 01.02.2019, p. 111-118.

Research output: Contribution to journalArticle

Langer, Thomas ; Santini, Alessandro ; Zadek, Francesco ; Chiodi, Manuela ; Pugni, Paola ; Cordolcini, Valentina ; Bonanomi, Barbara ; Rosini, Francesca ; Marcucci, Maura ; Valenza, Franco ; Marenghi, Cristina ; Inglese, Silvia ; Pesenti, Antonio ; Gattinoni, Luciano. / Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery : results of a randomized controlled pilot trial. In: Journal of Clinical Anesthesia. 2019 ; Vol. 52. pp. 111-118.
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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. Trial registration number: NCT02428062 www.clinicaltrials.gov.",
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AU - Langer, Thomas

AU - Santini, Alessandro

AU - Zadek, Francesco

AU - Chiodi, Manuela

AU - Pugni, Paola

AU - Cordolcini, Valentina

AU - Bonanomi, Barbara

AU - Rosini, Francesca

AU - Marcucci, Maura

AU - Valenza, Franco

AU - Marenghi, Cristina

AU - Inglese, Silvia

AU - Pesenti, Antonio

AU - Gattinoni, Luciano

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N2 - 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. Trial registration number: NCT02428062 www.clinicaltrials.gov.

AB - 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. Trial registration number: NCT02428062 www.clinicaltrials.gov.

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KW - Blood pressure

KW - Cognitive dysfunction

KW - Delirium

KW - Frail elderly

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