Key result
Intraoperative administration of nicardipine with or without esmolol significantly reduced the incidence of early post-operative cognitive dysfunction to 4.4% compared to 25.0% with control in elderly patients undergoing radiofrequency ablation for atrial fibrillation.
Why the study?
Does continuous intravenous infusion of nicardipine and/or nitroglycerin with or without esmolol reduce the incidence of early post-operative cognitive dysfunction in elderly patients undergoing radiofrequency ablation for atrial fibrillation?
RCT (n=340)
Double-blind
Computer-generated random number table
No
Does continuous intravenous infusion of nicardipine and/or nitroglycerin with or without esmolol reduce the incidence of early post-operative cognitive dysfunction in elderly patients undergoing radiofrequency ablation for atrial fibrillation?
Absolute Event Rate: 4.4% vs 25%
p-value: p=<0.01
Intraoperative use of nicardipine, with or without esmolol, significantly reduces the incidence of early post-operative cognitive dysfunction in elderly patients undergoing radiofrequency ablation for atrial fibrillation compared to nitroglycerin or saline.
OBJECTIVE: To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. METHODS: Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. RESULTS: At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. CONCLUSION: Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases.
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Sun et al. (2017) conducted an RCT in Atrial fibrillation (n=340). Nicardipine with or without esmolol vs. Normal saline (control) was evaluated on Incidence of early post-operative cognitive dysfunction (POCD) (p=<0.01). Intraoperative administration of nicardipine with or without esmolol significantly reduced the incidence of early post-operative cognitive dysfunction to 4.4% compared to 25.0% with control in elderly patients undergoing radiofrequency ablation for atrial fibrillation.
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