• Jiayi Wang, Guangmei Mao, Natasha Malackany, Donn Marciniak, Chase Donaldson, Brett Wakefield, Mohamed Hassan, Kurt Ruetzler, Daniel I Sessler, and Alparslan Turan.
• Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States of America; Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
• J Clin Anesth. 2022 Feb 1; 76: 110584.

Study ObjectiveTo test the hypotheses that in adults having cardiac surgery with cardio-pulmonary bypass, perioperative hypotension increases the risk of delirium and atrial fibrillation during the initial five postoperative days.DesignSub-analysis of the DECADE multi-center randomized trial.SettingPatients who had cardiac surgery with cardiopulmonary bypass at the Cleveland Clinic.InterventionsIn the underlying trial, patients were randomly assigned 1:1 to dexmedetomidine or normal saline placebo.MeasurementsIntraoperative mean arterial pressures were recorded at 1-min intervals from arterial catheters or at 1-5-min intervals oscillometrically. Postoperative blood pressures were recorded every half-hour or more often. The co-primary outcomes were atrial fibrillation and delirium occurring between intensive care unit admission and the earlier of postoperative day 5 or hospital discharge. Delirium was assessed twice daily during the initial 5 postoperative days while patients remained hospitalized with the Confusion Assessment Method for the intensive care unit. Assessments were made by trained research fellows who were blinded to the dexmedetomidine administration.Main ResultsThere was no significant association between intraoperative hypotension and delirium, with an adjusted odds ratio of 0.94 (95% CI: 0.81, 1.09; P = 0.419) for a doubling in AUC of mean arterial pressure (MAP) <60 mmHg. An increase in intraoperative AUC of MAP <60 mmHg was not significantly associated with the odds of atrial fibrillation (adjusted odds ratio = 0.99; 95% CI: 0.87, 1.11; P = 0.819). Postoperative MAP <70 mmHg per hour 1.14 (97.5% CI: 1.04,1.26; P = 0.002) and MAP <80 mmHg per hour 1.05 (97.5%: 1.01, 1.10; P = 0.010) were significantly associated with atrial fibrillation.ConclusionsIn patients having cardiac surgery with cardio-pulmonary bypass, neither intraoperative nor postoperative hypotension were associated with delirium. Postoperative hypotension was associated with atrial fibrillation, although intraoperative hypotension was not.Copyright © 2021 Elsevier Inc. All rights reserved.

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