Neurocognitive Performance in Hypertensive Patients after Spine Surgery

• Published in: Anesthesiology (Philadelphia) Vol. 110; no. 2; pp. 254 - 261
• Main Authors: YOCUM, Gene T, GAUDET, John G, TEVERBAUGH, Lauren A, QUEST, Donald O, MCCORMICK, Paul C, SANDER CONNOLLY, E, HEYER, Eric J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2009
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Cognition - physiology; Cohort Studies; Diskectomy; Female; Humans; Hypertension - physiopathology; Hypertension - psychology; Laminectomy; Linear Models; Male; Medical Records Systems, Computerized; Medical sciences; Middle Aged; Monitoring, Intraoperative; Neuropsychological Tests; Pain Measurement; Postoperative Complications - psychology; Risk Factors; Spine - surgery; Vasoconstrictor Agents - adverse effects; Vasoconstrictor Agents - therapeutic use; Human; Hypertension; Cardiovascular disease; Anesthesia; Spine; Surgery
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3181942c7a

Cognitive dysfunction is fairly common after noncardiac surgery and may be related to intraoperative blood pressure management. The authors present an analysis of risk factors for cognitive deterioration after spine surgery in older patients, with particular emphasis on intraoperative blood pressure in normotensive and hypertensive patients. This is a post hoc cohort analysis of 45 patients enrolled before undergoing lumbar laminectomy or microdiscectomy. The patients underwent a battery of 5 neuropsychometric tests preoperatively, and 1 day and 1 month postoperatively. Computerized anesthesia records were used to obtain intraoperative mean arterial pressure (MAP) data. Simple linear regressions between intraoperative MAP and postoperative cognitive performance were performed, and multivariate linear regression models of postoperative cognitive performance were constructed to analyze potential risk factors for cognitive decline after surgery. Twenty-one normotensive patients (mean age, 62.4 yr) and 24 hypertensive patients (mean age, 67.9 yr) were included in this analysis. There was a significant positive relationship between minimum intraoperative MAP values and 1-day cognitive performance by simple linear regression in hypertensive (P = 0.003), but not normotensive, patients. In multivariate linear regression analysis of cognitive performance, there was a significant interaction between hypertension and minimum intraoperative MAP at 1 day and 1 month. In hypertensive patients, there was a significant relationship between minimum intraoperative MAP and decline in cognitive function 1 day and 1 month after surgery. A prospective controlled trial of intraoperative blood pressure control, especially during induction of anesthesia when MAP values typically drop, is needed to confirm these findings.