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Minerva Anestesiologica 2021 May 03

DOI: 10.23736/S0375-9393.21.14759-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Comparison of arterial blood pressure and cardiac index-based hemodynamic management on cognitive function in elderly patients undergoing spinal surgery: a randomized clinical trial

Esra SAKA 1, Taner ABDULLAH 1 , Mert CANBAZ 1, Elif AYGUN 1, Ilyas DOLAS 2, Pulat A. SABANCI 2, Ibrahim O. AKINCI 1, Achmet ALI 1

1 Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; 2 Department of Neurosurgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey



BACKGROUND: Postoperative delayed neurocognitive recovery (DNR) is frequent in elderly patients. Prevention of DNR is essential to achieve a better postoperative outcome.
METHODS: The aim of the present study was to compare mean arterial pressure (MAP) and cardiac index (CI) based hemodynamic management on early cognitive function in elderly patients undergoing spinal surgery. Sixty patients aged ≥60 years were enrolled. Patients were randomized to one of two groups. In Group MAP, hemodynamic management of patients was performed according to the MAP value. In Group CI, hemodynamic management of patients was performed according to the CI value. In all patients, standard anesthesia method was used and regional cerebral oxygen saturation (rScO2) was measured. Cognitive functions of patients were assessed by Montreal cognitive assessment (MoCA) test before surgery and 7 days after surgery. Change in MoCA test (ΔMoCA) was calculated.
RESULTS: Postoperative MoCA score was significantly greater in Group CI (25.2 ± 2.4) than Group MAP (23.9 ± 2.5) (p = 0.046) . The ΔMoCAs were 1 (IQR, 0-3) and 3 (IQR, 2-3.5) in Group CI and MAP respectively (p<0.001). Lowest and average rScO2 values were significantly greater, and the decreased load of rScO2 below the threshold of 10% (AUCΔ10%) and 20% (AUCΔ20%) b elow its baseline were significantly lower in Group CI (p<0.05).
CONCLUSIONS: Cardiac index based hemodynamic management provided better postoperative cognitive function and higher intraoperative rScO2 when compared with MAP-based hemodynamic management.


KEY WORDS: Postoperative cognitive dysfunction; Cardiac output; Near-infrared Spectroscopy; Hemodynamic monitoring

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