Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial

• Published in: Journal of clinical anesthesia Vol. 69; p. 110150
• Main Authors: Hu, An-Min, Qiu, Yan, Zhang, Peng, Zhao, Rui, Li, Shu-Tao, Zhang, Yao-Xian, Zheng, Zi-Hao, Hu, Bai-Long, Yang, Ya-Li, Zhang, Zhong-Jun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021; Elsevier Limited
• Subjects: Blood pressure; Delirium; Diabetes; Elderly patients; General anaesthesia; General anesthesia; Heart surgery; Hypertension; Intensive care; Mean arterial pressure; Patients; Postoperative delirium; Statistical analysis; Variables; China; General anaesthesia; Postoperative delirium; Mean arterial pressure; Elderly patients
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2020.110150

This study aimed to evaluate the effects of low versus high mean arterial pressure (MAP) levels on the incidence of postoperative delirium during non-cardiothoracic surgery in older patients. Multicenter, randomized, parallel-controlled, open-label, and assessor-blinded clinical trial. University hospital. Three hundred twenty-two patients aged ≥65 with an American Society of Anesthesiologists physical status of I-II who underwent non-cardiothoracic surgery with general anaesthesia. Participants were randomly assigned into a low-level MAP (60–70 mmHg) or high-level MAP (90–100 mmHg) group during general anaesthesia. The study was conducted from November 2016 to February 2020. Participants were older patients having non-cardiothoracic surgery. The follow-up period ranged from 1 to 7 days after surgery. The primary outcome was the incidence of postoperative delirium. In total, 322 patients were included and randomized; 298 completed in-hospital delirium assessments [median (interquartile range) age, 73 (68–77) years; 173 (58.1%) women]. Fifty-four (18.1%) patients total, including 36 (24.5%) and 18 (11.9%) in the low-level and high-level MAP groups [relative risk (RR) 0.48, 95% confidence interval (CI) 0.25 to 0.87, P = 0.02], respectively, experienced postoperative delirium. The adjusted RR was 0.34 (95% CI 0.16 to 0.70, P < 0.01) in the multiple regression analysis. High-level MAP was associated with a shorter delirium span and a higher intraoperative urine volume than low-level MAP. In older patients during non-cardiothoracic surgery, high-level blood pressure management might help reduce the incidence of postoperative delirium. •Postoperative delirium is a common complication for elderly patients under general anaesthesia after surgery.•Blood pressure management with a high-level might provide benefits in reducing incident postoperative delirium.•Age, MMSE score, anaesthesia time, intraoperative blood loss, and use of PCIA were associated with postoperative delirium.