Key result
Cardiac Index-based hemodynamic management resulted in significantly higher postoperative MoCA scores compared to MAP-based management (25.2 vs 23.9; P=0.046).
Why the study?
Postoperative delayed neurocognitive recovery is frequent in elderly patients, and its prevention is essential to achieve a better postoperative outcome.
Does Cardiac Index-based hemodynamic management improve early cognitive function compared to MAP-based management in elderly patients undergoing spinal surgery?
RCT (n=60)
Does Cardiac Index-based hemodynamic management improve early cognitive function compared to MAP-based management in elderly patients undergoing spinal surgery?
Absolute Event Rate: 25.2% vs 23.9%
p-value: p=0.046
Cardiac Index-based hemodynamic management during spinal surgery in elderly patients results in better postoperative cognitive function and higher intraoperative cerebral oxygen saturation compared to MAP-based management.
CI-based management improved early cognition versus MAP targets in elderly spinal surgery; extends goal-directed hemodynamic strategies for neuroprotection.
BACKGROUND: Postoperative delayed neurocognitive recovery (DNR) is frequent in elderly patients. Prevention of DNR is essential to achieve a better postoperative outcome. METHODS: The aim of the present study was to compare mean arterial pressure (MAP) and Cardiac Index (CI) based hemodynamic management on early cognitive function in elderly patients undergoing spinal surgery. Sixty patients aged ≥60 years were enrolled. Patients were randomized to one of two groups. In Group MAP, hemodynamic management of patients was performed according to the MAP value. In Group CI, hemodynamic management of patients was performed according to the CI value. In all patients, standard anesthesia method was used and regional cerebral oxygen saturation (rScO2) was measured. Cognitive functions of patients were assessed by Montreal cognitive assessment (MoCA) test before surgery and seven days after surgery. Change in MoCA test (ΔMoCA) was calculated. RESULTS: Postoperative MoCA score was significantly greater in Group CI (25.2±2.4) than Group MAP (23.9±2.5) (P=0.046). The ΔMoCAs were 1 (IQR, 0-3) and 3 (IQR, 2-3.5) in Group CI and MAP respectively (P<0.001). Lowest and average rScO2 values were significantly greater, and the decreased load of rScO2 below the threshold of 10% (AUCΔ10%) and 20% (AUCΔ20%) below its baseline were significantly lower in Group CI (P<0.05). CONCLUSIONS: CI-based hemodynamic management provided better postoperative cognitive function and higher intraoperative rScO2 when compared with MAP-based hemodynamic management.
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Saka et al. (2021) conducted an RCT in elderly patients undergoing spinal surgery (n=60). Cardiac Index (CI) based hemodynamic management vs. Mean arterial pressure (MAP) based hemodynamic management was evaluated on Postoperative Montreal cognitive assessment (MoCA) score at 7 days (p=0.046). Cardiac Index-based hemodynamic management resulted in significantly higher postoperative MoCA scores compared to MAP-based management (25.2 vs 23.9; P=0.046).
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