Controlled Hypotension for Nasal Surgeries, Postoperative Cognitive Dysfunction (POCD)
Conditions
Keywords
Ear Surgery, Desflurane, Total Intravenous Anesthesia, Sevoflurane, Controlled Hypotension, Cognitive Function
Brief summary
This randomized prospective study aimed to compare desflurane, sevoflurane, and total intravenous anesthesia methods in patients undergoing elective ear surgery under controlled hypotension, with a particular focus on postoperative cognitive dysfunction. In addition to cognitive outcomes, intraoperative hemodynamic parameters, cerebral oxygenation, and perioperative clinical outcomes were evaluated and compared among the three groups.
Detailed description
Controlled hypotension is commonly used in ear surgery to reduce intraoperative bleeding and improve the surgical field. However, the effects of different anesthetic maintenance techniques used during controlled hypotension on postoperative cognitive function remain unclear. This prospective randomized study included adult patients undergoing elective ear surgery. Patients were randomly assigned to receive desflurane, sevoflurane, or total intravenous anesthesia for maintenance of anesthesia under controlled hypotension. The primary objective of the study was to evaluate postoperative cognitive dysfunction. Secondary objectives included comparison of intraoperative hemodynamic stability, cerebral oxygenation, and perioperative clinical outcomes among the three anesthesia techniques. Hemodynamic parameters and cerebral oxygen saturation were recorded at predefined time points during the intraoperative period. Postoperative cognitive function was assessed using standardized cognitive evaluation methods. The findings of this study aim to contribute to the selection of optimal anesthetic techniques in ear surgery performed under controlled hypotension.
Interventions
DRUGDesflurane
Used for maintenance of anesthesia.
DRUGSevoflurane
Used for maintenance of anesthesia.
DRUGRemifentanil
Used for maintenance of anesthesia.
Used for maintenance of anesthesia.
Sponsors
Dr. Lutfi Kirdar Kartal Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessments were performed by an independent investigator who was blinded to group allocation. The individual responsible for intraoperative management and intervention was different from the investigator performing postoperative evaluations.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years and older * ASA physical status I-II * Scheduled for elective tympanoplasty, mastoidectomy, or tympanomastoidectomy under general anesthesia * Provided written informed consent
Exclusion criteria
* Patients with known neurological or psychiatric disorders affecting cognitive function * Pre-existing cognitive impairment * Severe hepatic or renal insufficiency * History of alcohol or substance abuse * Inability to complete cognitive function tests * Emergency surgery * Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative cognitive function (POCD) | Preoperative baseline and postoperative day 7 | Postoperative cognitive function was evaluated using standardized neurocognitive tests before surgery and on postoperative day 7. Changes from baseline were analyzed to assess postoperative cognitive dysfunction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative cerebral oxygen saturation (rSO2) | Preoperative baseline (T0); 5, 15, 30, 45, and 60 minutes after intubation (T1-T5); and 5 and 15 minutes after extubation (T6-T7). | Regional cerebral oxygen saturation (rSO2) was continuously monitored intraoperatively using near-infrared spectroscopy (NIRS) and compared between groups at predefined time points. |
| Mean Arterial Pressure | Preoperative baseline (T0); 5, 15, 30, 45, and 60 minutes after intubation (T1-T5); and 5 and 15 minutes after extubation (T6-T7). | Mean arterial pressure (MAP) was recorded intraoperatively at predefined time points and compared between the three anesthesia groups. |
| Arterial Partial Pressure of Oxygen | 15 minutes (T2) and 60 minutes (T5) after intubation. | Arterial partial pressure of oxygen (PaO₂) was measured intraoperatively at predefined time points and compared between the three anesthesia groups. |
| Heart Rate | Preoperative baseline (T0); 5, 15, 30, 45, and 60 minutes after intubation (T1-T5); and 5 and 15 minutes after extubation (T6-T7). | Heart rate (HR) was recorded intraoperatively at predefined time points and compared between the three anesthesia groups. |
| Arterial Partial Pressure of Carbon Dioxide | 15 minutes (T2) and 60 minutes (T5) after intubation. | Arterial partial pressure of carbon dioxide (PaCO₂) was measured intraoperatively at predefined time points and compared between the three anesthesia groups. |
| Blood Lactate Level | 15 minutes (T2) and 60 minutes (T5) after intubation. | Blood lactate level was measured intraoperatively at predefined time points and compared between the three anesthesia groups. |
Countries
Turkey (Türkiye)
Outcome results
None listed