Key result
Esmolol and nitroglycerin showed no significant difference in the incidence of postoperative cognitive dysfunction (35% vs 45%, p>0.05) during controlled hypotension for nasal surgery.
Why the study?
The study aimed to evaluate the effect of controlled hypotension on cerebral oxygen saturation and postoperative cognitive dysfunction in patients undergoing nasal surgery.
Does esmolol compared to nitroglycerin for controlled hypotension affect cerebral oxygen saturation and postoperative cognitive dysfunction in patients undergoing nasal surgery?
RCT (n=40)
Double-blind
Sealed envelope method
No
Does esmolol compared to nitroglycerin for controlled hypotension affect cerebral oxygen saturation and postoperative cognitive dysfunction in patients undergoing nasal surgery?
Absolute Event Rate: 35% vs 45%
p-value: p=>0.05
During controlled hypotension for nasal surgery, cerebral desaturation is associated with early postoperative cognitive dysfunction, regardless of whether esmolol or nitroglycerin is used.
Close cerebral monitoring during controlled hypotension may reduce early POCD risk; leaves open causal links and optimal thresholds.
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.
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Aydın et al. (2021) conducted an RCT in Nasal surgery requiring controlled hypotension (n=40). Esmolol vs. Nitroglycerin (0.5-2 μg/kg/min) was evaluated on Postoperative cognitive dysfunction (POCD) at 24 hours (p=>0.05). Esmolol and nitroglycerin showed no significant difference in the incidence of postoperative cognitive dysfunction (35% vs 45%, p>0.05) during controlled hypotension for nasal surgery.
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