Comparison Of Arterial Blood Pressure And Cardiac Index-Based Hemodynamic Management On Cognitive Function In Elderly Patients Undergoing Spinal Surgery: A Randomized Clinical Trial

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 (rScO(2)) 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 (Delta MoCA) was calculated.RESULTS: Postoperative MoCA score was significantly greater in Group CI (252 +/- 2.4) than Group MAP (23.9 +/- 2.5) (P=0.046). The Delta MoCAs were 1 (IQR, 0-3) and 3 (IQR, 2-3.5) in Group CI and MAP respectively (P<0.001). Lowest and average rScO(2) values were significantly greater, and the decreased load of rScO(2) below the threshold of 10% (AUC Delta 10%) and 20% (AUC Delta 20%) 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 rScO(2) when compared with MAP-based hemodynamic management.