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Journal of Clinical Monitoring and Computing

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01-04-2018 | Original Research

Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery

Authors: Hongyi Li, Qiaochu Fu, Zongfang Wu, Jiaoli Sun, Anne Manyande, Hui Yang, Peng Wang

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2018

Abstract

Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO₂) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO₂ in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO₂. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO₂ and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO₂ of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUC_{rSO2 <90% of baseline} and AUC_{rSO2 <80% of baseline}) was lower in patients of group N (2752.4 ± 1453.3 min% and 0.0 min%) than in patients of group D (6264.9 ± 1832.3 min% and 4486.5 ± 1664.9 min%, P < 0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P = 0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO₂ (r² = 0.495, P < 0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P = 0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov).

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Sakudo A. Near-infrared spectroscopy for medical applications: current status and future perspectives. Clin Chim Acta. 2016;455:181–8. doi:10.1016/j.cca.2016.02.009.CrossRefPubMed

Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth. 2005;52(1):79–87. doi:10.1007/bf03018586.CrossRefPubMed

Vretzakis G, Georgopoulou S, Stamoulis K, Stamatiou G, Tsakiridis K, Zarogoulidis P, Katsikogianis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Mpakas A, Beleveslis T, Koletas A, Siminelakis SN, Zarogoulidis K. Cerebral oximetry in cardiac anesthesia. J Thorac Dis. 2014;6(Suppl 1):S60–9. doi:10.3978/j.issn.2072-1439.2013.10.22.PubMedPubMedCentral

Zacharias DG, Lilly K, Shaw CL, Pirundini P, Rizzo RJ, Body SC, Longford NT. Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28(2):308–16. doi:10.1053/j.jvca.2013.06.003.CrossRefPubMed

Michel A, Weigand MA, Eckstein HH, Martin E, Bardenheuer HJ. Measurement of local oxygen parameters for detection of cerebral ischemia. The significance of cerebral near-infrared spectroscopy and transconjunctival oxygen partial pressure in carotid surgery. Anaesthesist. 2000;49(5):392–401.CrossRefPubMed

Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000;93(4):964–70.CrossRefPubMed

Hemmerling TM, Bluteau MC, Kazan R, Bracco D. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth. 2008;101(6):870–5. doi:10.1093/bja/aen275.CrossRefPubMed

Kazan R, Bracco D, Hemmerling TM. Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth. 2009;103(6):811–6. doi:10.1093/bja/aep309.CrossRefPubMed

Tang L, Kazan R, Taddei R, Zaouter C, Cyr S, Hemmerling TM. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth. 2012;108(4):623–9. doi:10.1093/bja/aer501.CrossRefPubMed

10.

Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S, Collaborative Italian Study Group on Anaesthesia in Elderly Patients, Danelli G, Nuzzi M, Mentegazzi F, Torri G, Martani C, Spreafico E, Fierro G, Pugliese F, De Cosmo G, Aceto P, Servillo G, Monaco F. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol. 2007;24 (1):59–65. doi:10.1017/S0265021506001025.PubMed

11.

Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, Fierro G, De Cosmo G, Servillo G. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005;101(3):740–747. doi:10.1213/01.ane.0000166974.96219.cd (table of contents)CrossRefPubMed

12.

Nielsen HB. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front Physiol. 2014;5:93. doi:10.3389/fphys.2014.00093.CrossRefPubMedPubMedCentral

13.

Sorensen H, Grocott HP, Secher NH. Near infrared spectroscopy for frontal lobe oxygenation during non-vascular abdominal surgery. Clin Physiol Funct Imaging. 2016;36(6):427–35. doi:10.1111/cpf.12244.CrossRefPubMed

14.

Pires PW, Dams Ramos CM, Matin N, Dorrance AM. The effects of hypertension on the cerebral circulation. Am J Physiol Heart Circ Physiol. 2013;304(12):H1598–H1614. doi:10.1152/ajpheart.00490.2012.CrossRefPubMedPubMedCentral

15.

Levin MA, Fischer GW, Lin HM, McCormick PJ, Krol M, Reich DL. Intraoperative arterial blood pressure lability is associated with improved 30 day survival. Br J Anaesth. 2015;115(5):716–26. doi:10.1093/bja/aev293.CrossRefPubMed

16.

Hanada S, Kawakami H, Goto T, Morita S. Hypertension and anesthesia. Curr Opin Anaesthesiol. 2006;19(3):315–9. doi:10.1097/01.aco.0000192811.56161.23.CrossRefPubMed

17.

Chiang CE, Wang TD, Ueng KC, Lin TH, Yeh HI, Chen CY, Wu YJ, Tsai WC, Chao TH, Chen CH, Chu PH, Chao CL, Liu PY, Sung SH, Cheng HM, Wang KL, Li YH, Chiang FT, Chen JH, Chen WJ, Yeh SJ, Lin SJ. 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension. J Chin Med Assoc 2015;78(1):1–47. doi:10.1016/j.jcma.2014.11.005.CrossRefPubMed

18.

Liu LS. 2010 Chinese guidelines for the management of hypertension. Zhonghua xin xue guan bing za zhi. 2011;39(7):579–615.PubMed

19.

Whitworth JA, World Health Organization ISoHWG. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983–92. doi:10.1097/01.hjh.0000084751.37215.d2.CrossRefPubMed

20.

Deschamps A, Hall R, Grocott H, et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery: a randomized controlled feasibility trial. Anesthesiology. 2016;124(4):826–36. doi:10.1097/ALN.0000000000001029.CrossRefPubMed

21.

Arevalo-Rodriguez I, Smailagic N, Roque IFM, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2015;(3):CD010783. doi:10.1002/14651858.CD010783.pub2.

22.

Guerrero-Berroa E, Luo X, Schmeidler J, Rapp MA, Dahlman K, Grossman HT, Haroutunian V, Beeri MS. The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly. Int J Geriatr Psychiatry. 2009;24(12):1429–37. doi:10.1002/gps.2282.CrossRefPubMedPubMedCentral

23.

Burdick DJ, Cholerton B, Watson GS, Siderowf A, Trojanowski JQ, Weintraub D, Ritz B, Rhodes SL, Rausch R, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Srivatsal S, Edwards KL, Montine TJ, Zabetian CP, Leverenz JB. People with Parkinson’s disease and normal MMSE score have a broad range of cognitive performance. Mov Disord. 2014;29(10):1258–64. doi:10.1002/mds.25924.CrossRefPubMedPubMedCentral

24.

Lin R, Zhang F, Xue Q, Yu B. Accuracy of regional cerebral oxygen saturation in predicting postoperative cognitive dysfunction after total hip arthroplasty: regional cerebral oxygen saturation predicts POCD. J Arthroplasty. 2013;28(3):494–7. doi:10.1016/j.arth.2012.06.041.CrossRefPubMed

25.

Suehiro K, Okutai R. Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score. J Anesth. 2011;25(3):345–9. doi:10.1007/s00540-011-1136-1.CrossRefPubMed

26.

Green DW. A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery. Eur J Anaesthesiol. 2007;24(3):230–4. doi:10.1017/S0265021506001645.CrossRefPubMed

27.

Kannel WB. Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens. 2000;13(1 Pt 2):3S–10S.

28.

Moerman A, Vandenplas G, Bove T, Wouters PF, De Hert SG. Relation between mixed venous oxygen saturation and cerebral oxygen saturation measured by absolute and relative near-infrared spectroscopy during off-pump coronary artery bypass grafting. Br J Anaesth. 2013;110(2):258–65. doi:10.1093/bja/aes375.CrossRefPubMed

29.

Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, Tromberg BJ, Mantulin WW. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011;107(2):209–17. doi:10.1093/bja/aer150.CrossRefPubMedPubMedCentral

30.

Tryambake D, He J, Firbank MJ, O’Brien JT, Blamire AM, Ford GA. Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension. Hypertension. 2013;61(6):1309–15. doi:10.1161/HYPERTENSIONAHA.112.200972.CrossRefPubMed

31.

Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007;107(2):213–20. doi:10.1097/01.anes.0000270724.40897.8e.CrossRefPubMed

32.

Grocott HP. Avoid hypotension and hypoxia: an old anesthetic adage with renewed relevance from cerebral oximetry monitoring. Can J Anaesth. 2011;58(8):697–702. doi:10.1007/s12630-011-9529-z.CrossRefPubMed

33.

Newman MF, Croughwell ND, White WD, Lowry E, Baldwin BI, Clements FM, Davis RD, Jr., Jones RH, Amory DW, Reves JG. Effect of perfusion pressure on cerebral blood flow during normothermic cardiopulmonary bypass. Circulation 1996;94(9 Suppl):II353–357.

34.

Murkin JM, Farrar JK, Tweed WA, McKenzie FN, Guiraudon G. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2. Anesth Analg. 1987;66(9):825–32.PubMed

35.

Joshi B, Ono M, Brown C, Brady K, Easley RB, Yenokyan G, Gottesman RF, Hogue CW. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg. 2012;114(3):503–10. doi:10.1213/ANE.0b013e31823d292a.CrossRefPubMed

36.

Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119–25. doi:10.3238/arztebl.2014.0119.PubMedPubMedCentral

37.

Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110(Suppl 1):i98–i105. doi:10.1093/bja/aet055.CrossRefPubMed

Title: Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery
Authors: Hongyi Li
Qiaochu Fu
Zongfang Wu
Jiaoli Sun
Anne Manyande
Hui Yang
Peng Wang
Publication date: 01-04-2018
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2018
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-017-0024-0

At a glance: The STEP trials

Springer Medicine

Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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