Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Abstract

Objective: To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. Methods: Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. Results: At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. Conclusion: Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases. Afri Health Sci2016;16(4): 1056-1066

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

“…Esmolol is a β-blocker that can inhibit reflex tachycardia, decrease myocardial oxygen consumption, reduce cardiac output (CO), and finally lower the MAP ( 23 ). Sun et al demonstrated that deliberate hypotension using nicardipine combined with esmolol not only maintained hemodynamic stability and decreased perioperative stress response, but also reduced the incidence of POCD in elderly patients ( 24 ). Therefore, in our study, continuous infusion of nicardipine plus esmolol was used to maintain MAP at 70% of the baseline in the intervention group.…”

Assessing effect of anaesthetic methods on postoperative cognitive dysfunction

“…The available evidence indicates that maintenance of stable intraoperative haemodynamics can reduce the incidence of POCD in elderly patients. 4 Similarly, a recent meta-analysis shows that perioperative use of dexmedetomidine can reduce the incidence of POCD and improve the postoperative mini-mental state examination score. 5 In contrast, intraoperative blood transfusion of >3 units is an independent risk factor for POCD in elderly patients after total hip replacement surgery.…”

The Association Between Hypertension and Cognitive Impairment, and the Role of Antihypertensive Medications: A Literature Review

“…They suggested that the systolic blood pressure elevation in the first 24 hours after ICH might be linked to CI. Sun et al also looked at an acute rise in blood pressure [ 23 ]. They conducted an RCT that studied the effect of nicardipine (CCB), nitroglycerin, esmolol (BB), in preventing postoperative cognitive dysfunction (POCD) in elderly patients who underwent surgery and anesthesia, and the incidence of POCD.…”

“…They found that the patients who received either nicardipine alone or in combination with esmolol had a far lesser incidence of POCD than those that did not receive these interventions. They also specifically mentioned that the absence of ICH complications in all groups, suggesting that POCD may occur independently of complications [ 23 ].…”