Changes in cerebral oxygenation and cognitive functions during controlled hypotension

Year 2021, Volume: 46 Issue: 4, 1614 - 1623, 30.12.2021

Bengü Gülhan Aydın , Gamze Küçükosman , Özcan Pişkin , Necla Gülçek Rahşan Dilek Okyay , Hilal Ayoğlu

https://doi.org/10.17826/cumj.986099

Abstract

Purpose: This study aimed to evaluate the effect of controlled hypotension on cerebral oxygen saturation and postoperative cognitive dysfunction (POCD) in patients undergoing nasal surgery.
Materials and Methods: Forty patients were randomized by a sealed envelope method into two drug groups: esmolol (Group E, n=20) or nitroglycerin (Group N, n=20) administration prior to surgical incision. The cognitive functions of the patients were evaluated by the Mini-Mental State Examination Test 1 day before and 1 day after the operation. Regional oxygen saturation was monitored with near-infrared spectroscopy to detect cerebral desaturation.
Results: The desired mean arterial blood pressure (50-65 mmHg) could be achieved in all groups. A decline in cognitive function occured in 16 patients (40%) at the 24th postoperative hour. There was no statistically significant difference between the groups in terms of POCD. There was a significant relationship between POCD and cerebral desaturation status.
Conclusion: Cerebral desaturation seen during hypotensive anesthesia may cause early POCD development, therefore we think that close cerebral and hemodynamic monitoring during hypotensive anesthesia may preserve cognitive functions.

Keywords

Hypotensive anesthesia, cerebral oxygenation, cognitive function, esmolol, nitroglycerin

Kontrollü hipotansiyon sırasında serebral oksijenasyon ve kognitif fonksiyonlarda meydana gelen değişiklikler

Abstract

Amaç: Bu çalışmada, nazal cerrahi geçiren hastalarda uygulanan kontrollü hipotansiyonun serebral oksijen satürasyonu ve postoperatif kognitif disfonksiyon (POKD) üzerindeki etkisinin değerlendirmesi amaçlandı.
Gereç ve Yöntem: Kırk hasta kapalı zarf yöntemi ile esmolol (Grup E, n=20) ve nitrogliserin (Grup N, n=20) olmak üzere iki gruba ayrıldı. Hastaların kognitif fonksiyonları operasyondan 1 gün önce ve 1 gün sonra Mini Mental Durum Testi ile değerlendirildi. Serebral desatürasyonu saptamak için rejyonel serebral oksijen satürasyonu yakın kızılötesi spektroskopi ile izlendi.
Bulgular: Tüm gruplarda istenilen ortalama arteriyel kan basıncına (50-65 mmHg) ulaşıldı. Postoperatif 24. saatte 16 hastada (%40) kognitif fonksiyonlarda azalma meydana geldi. Postoperatif kognitif disfonksiyon açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu. Postoperatif kognitif disfonksiyon ile serebral desatürasyon arasında anlamlı bir ilişki olduğu görüldü.
Sonuç: Hipotansif anestezi sırasında görülen serebral desatürasyon erken POKD gelişimine neden olabilmektedir, bu nedenle hipotansif anestezi sırasında yakın serebral ve hemodinamik monitorizasyon ile kognitif fonksiyonların korunabileceğini düşünmekteyiz.

Keywords

Hipotansif anestezi, serebral oksijenasyon, kognitif fonksiyon, esmolol, nitrogliserin

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