Key result
A decrease in mean arterial pressure during hypotensive anesthesia was significantly correlated with a drop in cerebral oxygen saturation (rho = 0.6, p < 0.001) in hypertensive patients undergoing transsphenoidal surgery.
Why the study?
Controlled hypotension during transsphenoidal surgery carries risks of cerebral hypoperfusion, especially in hypertensive patients with altered autoregulation, requiring evaluation of safe blood pressure limits.
Does a decrease in mean arterial pressure reduce cerebral oxygen saturation in hypertensive patients during hypotensive anesthesia for transsphenoidal surgery?
Observational (n=30)
No
Does a decrease in mean arterial pressure reduce cerebral oxygen saturation in hypertensive patients during hypotensive anesthesia for transsphenoidal surgery?
Continuous cerebral oximetry monitoring during hypotensive anesthesia in hypertensive patients can provide early warning of cerebral desaturation when MAP drops below 70 mmHg or >30% from baseline.
Answers are grounded in this paper and cite their sources.
May support cerebral oximetry monitoring at MAP thresholds; leaves open outcome impact in prospective trials.
Controlled hypotension is employed for transsphenoidal surgeries (TSS) to provide a bloodless surgical field carries the potential risk of cerebral hypoperfusion and neurological injury. Pituitary adenoma may present with a high incidence of hypertension due to associated acromegaly and Cushing's disease. The risk of cerebral hypoperfusion increases with a decrease in blood pressure in chronic hypertensive patients due to a rightward shift of the autoregulation curve. This observational study aimed to correlate the changes in cerebral oxygenation (ScO2) with reduction in mean arterial pressure (MAP) in hypertensive patients undergoing TSS to determine the safety limit of permissive hypotension. Thirty hypertensive patients undergoing transsphenoidal pituitary surgery under hypotension anesthesia (targeted MAP 60–70 mm Hg) were included. Calibrated near-infrared spectroscopy was used to record continuous ScO2. A decrease in the absolute value of ScO2 <50 or ≥20% drop from baseline was considered significant. Patients were monitored after surgery for hemodynamic instability, cognitive dysfunction, and any neurological complications. Eleven out of 30 patients showed a significant drop in ScO2. A decrease in MAP < 70 mm Hg or more than 30% from baseline was associated with a significant reduction in ScO2. A fair positive correlation between decrease in MAP and drop in ScO2 (rho = 0.6, p < 0.001) was observed. The duration of hypertension and ventricular hypertrophy was also associated with a decrease in ScO2. Postoperative cognitive score was low on day 1 after surgery in patients having deceased ScO2 (p = 0.045). Our study showed that ScO2 monitoring can play a pivotal role in managing MAP during hypotensive anesthesia. It can provide an early warning sign of decreased ScO2, enabling rapid intervention to prevent postoperative neurological deficit.
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Vijayakumar et al. (2025) conducted an observational in Hypertension in patients undergoing transsphenoidal surgery for pituitary tumor (n=30). Decrease in mean arterial pressure vs. Baseline mean arterial pressure was evaluated on Correlation between percent change in mean arterial pressure and maximum drop in cerebral oxygen saturation (rho = 0.6, p=<0.001). A decrease in mean arterial pressure during hypotensive anesthesia was significantly correlated with a drop in cerebral oxygen saturation (rho = 0.6, p < 0.001) in hypertensive patients undergoing transsphenoidal surgery.
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