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 language | English |
|---|---|
| Pages (from-to) | 111-118 |
| Number of pages | 8 |
| Journal | Journal of Clinical Anesthesia |
| Volume | 52 |
| DOIs | |
| Publication status | Published - Feb 1 2019 |
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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 journal › Article
}
TY - JOUR
T1 - Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery
T2 - results of a randomized controlled pilot trial
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
PY - 2019/2/1
Y1 - 2019/2/1
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.
KW - Anesthesia, general
KW - Blood pressure
KW - Cognitive dysfunction
KW - Delirium
KW - Frail elderly
UR - http://www.scopus.com/inward/record.url?scp=85053471223&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053471223&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2018.09.021
DO - 10.1016/j.jclinane.2018.09.021
M3 - Article
C2 - 30243062
AN - SCOPUS:85053471223
VL - 52
SP - 111
EP - 118
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
SN - 0952-8180
ER -