• Thomas Langer, Alessandro Santini, Francesco Zadek, Manuela Chiodi, Paola Pugni, Valentina Cordolcini, Barbara Bonanomi, Francesca Rosini, Maura Marcucci, Franco Valenza, Cristina Marenghi, Silvia Inglese, Antonio Pesenti, and Luciano Gattinoni.
• Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: Thomas.Langer@unimi.it.
• J Clin Anesth. 2019 Feb 1; 52: 111-118.

Study ObjectiveTo assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial.DesignRandomized controlled pilot trial.SettingPerioperative care in a tertiary care teaching hospital with outpatient follow-up.PatientsOne hundred one patients aged ≥75 years with ASA physical status <4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls.InterventionsRandomization to a personalized intraoperative blood pressure target, mean arterial pressure (MAP) ≥ 90% of preoperative values (Target group), or to a more liberal intraoperative blood pressure management (No-Target group). Strategies to reach intraoperative blood pressure target were at discretion of anesthesiologists.MeasurementsAn experienced neuropsychologist performed a validated battery of neurocognitive tests preoperatively and 3 months after surgery. Incidence of POCD at three months and postoperative delirium were assessed. Intraoperative time spent with MAP ≥ 90% of preoperative values, recruitment and drop-out rate at 3 months were feasibility outcomes.Main ResultsThe Target group spent a higher percentage of intraoperative time with MAP ≥90% of preoperative values (65 ± 25% vs. 49 ± 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No correlation was found between intraoperative hypotension and postoperative cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate was of 6 patients/month (95% confidential interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14 to 33%).ConclusionsIntraoperative hypotension did not correlate with postoperative cognitive dysfunction or delirium occurrence in elderly patients undergoing general anesthesia for non-cardiac surgery. A multicenter randomized controlled trial is needed in order to confirm the effect of intraoperative blood pressure on the development of POCD.Trial Registration NumberNCT02428062www.clinicaltrials.gov.Copyright © 2018 Elsevier Inc. All rights reserved.

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