Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery

Abstract

Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUC and AUC) was lower in patients of group N (2752.4 ± 1453.3 min% and 0.0 min%) than in patients of group D (6264.9 ± 1832.3 min% and 4486.5 ± 1664.9 min%, P < 0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P = 0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO (r = 0.495, P < 0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P = 0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov ).

Morphological Changes in the Somatosensory Cortex of Guinea Pigs Following Simulation of the Abdominal Surgery Wound

“…Данные литературы подтверждают результаты нашего морфологического исследования, демонстрируя наличие послеоперационных изменений, которые могут быть вызваны уменьшением оксигенации головного мозга. Среди них -митохондриальная дисфункция в гиппокампе и префронтальной коре у мышей после хирургической лапаротомии [14], наличие церебральной дезоксигенации при абдоминальной хирургии у людей по данным инфракрасной спектроскопии [16]; снижение регионарного насыщения мозга кислородом во время абдоминальных операций [13]. Следует отметить, что послеоперационные изменения в мозге могут быть также связаны с периферическим воспалением в области абдоминальной раны [15].…”

Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

“…Another study by Li and co-workers [16]—published in April 2018 in this journal—performed in hypertensive patients undergoing major abdominal surgery, investigated the incidence of intraoperative cerebral oxygen desaturation, and determined its association with changes in cognitive function tests. The attending anesthesiologists were blinded for cerebral oxygenation readings during anesthesia.…”

Effect of rScO2-Guided Blood Pressure Management on Postoperative Complications in Elderly Patients After Major Noncardiac Surgery: Protocol for a Randomized Controlled Trial

“…Low rScO 2 values were associated with perioperative low hemoglobin concentration, cognitive dysfunction, prolonged recovery, and increased complications and deaths after cardiac and noncardiac surgery. 8–11 With the index organ of brain, rScO 2 has been considered to reflect global perfusion, and thus strategies that optimize rScO 2 may improve perfusion in vital organs and patients’ clinical outcomes. 12 , 13 …”

“…Low rScO 2 values were associated with perioperative low hemoglobin concentration, cognitive dysfunction, prolonged recovery, and increased complications and deaths after cardiac and noncardiac surgery. [8][9][10][11] With the index organ of brain, rScO 2 has been considered to reflect global perfusion, and thus strategies that optimize rScO 2 may improve perfusion in vital organs and patients' clinical outcomes. 12,13 In this context, we design this randomized clinical study to evaluate the use of rScO 2 -guided blood pressure management strategy through individualized rScO 2 optimization among older adults who undergo major noncardiac surgery.…”