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

Länger, Thomas; Santini, Alessandro; Zadek, Francesco; Chiodi, M; Pugni, Paola; Cordolcini, Valentina; Bonanomi, Barbara; Rosini, Francesca; Marcucci, Maura; Valenza, Franco; Marenghi, C.; Inglese, Silvia; Artigas, Antonio; Gattinoni, Luciano

doi:10.1016/j.jclinane.2018.09.021

Cited by 51 publications

(75 citation statements)

References 33 publications

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“…Although some evidence indicates that intraoperative haemodynamic fluctuation (i.e. hypotension) is associated with an increased risk of postoperative delirium, the relationship remains uncertain in elderly patients undergoing non‐cardiac surgery. Haemodynamic adverse events were reported in Table S2 of our study.…”

mentioning

confidence: 89%

Author response: Postoperative delirium in elderly patients: diagnosis and risk factors

2020

British Journal of Surgery

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mentioning

confidence: 89%

Author response: Postoperative delirium in elderly patients: diagnosis and risk factors

2020

British Journal of Surgery

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“…According to the criteria mentioned above, the remaining 134 studies were excluded, and ve studies were included in our nal analysis [9,[20][21][22][23]. The ow diagram describing the study search is displayed in Figure 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The main characteristics of included studies are summarized in Table 1. Two studies assessed the incidence of POD [9,21], and four assessed POCD [20][21][22][23] (one assessed both POD and POCD [21]).…”

Section: Study Characteristicsmentioning

confidence: 99%

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The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

Feng

Hua

et al. 2020

Preprint

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Abstract Background: There is no consensus on whether intraoperative hypotension is associated with postoperative cognitive impairment. Hence, we performed a meta-analysis to evaluate the correlation of intraoperative hypotension and the incidence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).Methods: We searched PubMed, Embase, and Cochrane Library databases to find randomized controlled trials (RCTs) in which reported the relationship between intraoperative hypotension and POD or POCD. The retrieval time is up to January 2020, without language restrictions. Quality assessment of the eligible studies was conducted by two researchers independently with the Cochrane evaluation system.Results: We analyzed five eligible RCTs. Based on the relative mean arterial pressure (MAP), participants were divided into low-target and high-target groups. For the incidence of POD, there were two studies with 99 participants in the low-target group and 94 participants in the high-target pressure group. For the incidence of POCD, there were four studies involved 360 participants in the low-target group and 341 participants in the high-target group, with a study assessed both POD and POCD. No significant difference between the low-target and the high-target group was observed in the incidence of POD (RR = 3.30, 95% CI 0.80 to 13.54, P = 0.10), or POCD (RR = 1.26, 95% CI 0.76 to 2.08, P = 0.37). Furthermore, it also demonstrates that intraoperative hypotension prolonged the length of ICU stay, but did not increased the mortality, the length of hospital stay, and mechanical ventilation (MV) time.Conclusions: There is no significant correlation between intraoperative hypotension and the incidence of POD or POCD. Keywords: Intraoperative hypotension, Postoperative delirium, Postoperative cognitive dysfunction, Meta-analysis

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“…In addition, many risk factors cannot be avoided. 39 A lack of knowledge concerning assessment tools as well as a lack of policies for managing these patients was found in other countries too, eg, Sweden. 40 Also, specific treatment options for POCD are lacking 4 even though prevention of POD seems crucial for the long-term cognitive outcome, and similar to POD prevention, activating therapy seems to alleviate cognitive function.…”

Section: Awareness On the Rise?mentioning

confidence: 99%

<p>Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers</p>

Sturm¹,

Wildermuth²,

Stolz³

et al. 2019

CIA

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Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The oftensuggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.

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

Cited by 51 publications

References 33 publications

Author response: Postoperative delirium in elderly patients: diagnosis and risk factors

Author response: Postoperative delirium in elderly patients: diagnosis and risk factors

The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

<p>Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers</p>

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