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Controlled hypotension is currently used in spinal surgery to reduce bleeding at the surgical site, improve the surgeon's visibility, and decrease intraoperative blood loss. Although controlled hypotension is considered a beneficial method from a surgical perspective, it is important to be cautious about its side effects. One such side effect is cerebral perfusion insufficiency, which can be managed by monitoring cerebral circulation through regional cerebral oxygen saturation (rSO2).
The aim of this study is to compare the effects of controlled hypotension at specific MAP ranges on cerebral oxygen saturation.
Controlled hypotension is currently used in spinal surgery to reduce bleeding at the surgical site, improve the surgeon's visibility, and decrease intraoperative blood loss. Although controlled hypotension is considered a beneficial method from a surgical perspective, it is important to be cautious about its side effects. One such side effect is cerebral perfusion insufficiency, which can be managed by monitoring cerebral circulation through regional cerebral oxygen saturation (rSO2).
In the literature, various definitions of controlled hypotension exist. It is commonly defined as maintaining the Mean Arterial Pressure (MAP) between 50-65 mmHg, Systolic Arterial Pressure (SAP) between 80-90 mmHg, or reducing MAP by 30% compared to baseline values. In our study, we plan to maintain the MAP within the range of 55-75 mmHg and compare the effects of two different MAP levels on perioperative cerebral oxygen saturation, anesthetic and surgical parameters, and postoperative cognitive functions.
The aim of this study is to compare the effects of controlled hypotension at specific MAP ranges on cerebral oxygen saturation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group MAP 55-65 mmHg | Other | Group - MAP 55-65 mmHg: MAP will be maintained between 55-65 mmHg during anesthesia. |
|
| Group MAP 66-75 mmHg | Other | Group - MAP 66-75 mmHg: MAP will be maintained between 66-75 mmHg during anesthesia. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MAP 55-65 mmHg | Other | MAP will be maintained between 55-65 mmHg during anesthesia. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | 5 minutes before induction of anesthesia |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | 5 minutes after intubation |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | 5 minutes after positioning prone |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | 1 minutes after first surgical incision is made |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | the time after one minutes target MAP value |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | the time after ten minutes target MAP value |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | the time after 20 minutes target MAP value |
| Near infrared spectroscopy (NIRS) | cerebral oxygen saturation | 5 minutes after extubation |
| Measure | Description | Time Frame |
|---|---|---|
| mini mental test | It is used to evaluate cognitive function. | 15 minutes before induction of anesthesia |
| mini mental test | It is used to evaluate cognitive function. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| damla usalan | Contact | +905059181063 | dusalan78@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| damla usalan | Ankara Etlik City Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Etlik City Hospital | Ankara | Varlık Mahallesi Yenimahalle | 06170 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15197633 | Background | Dutton RP. Controlled hypotension for spinal surgery. Eur Spine J. 2004 Oct;13 Suppl 1(Suppl 1):S66-71. doi: 10.1007/s00586-004-0756-7. Epub 2004 Jun 9. | |
| 37736691 | Result | Ooms M, Schooss R, Winnand P, Heitzer M, Holzle F, Bickenbach J, Rieg A, Modabber A. Influence of perioperative blood pressure regulation on postoperative delirium in patients undergoing head and neck free flap reconstruction. Eur J Med Res. 2023 Sep 22;28(1):365. doi: 10.1186/s40001-023-01367-1. |
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| ID | Term |
|---|---|
| D007022 | Hypotension |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| MAP 66-75 mmHg |
| Other |
MAP will be maintained between 66-75 mmHg during anesthesia. |
|
| Near infrared spectroscopy (NIRS) |
cerebral oxygen saturation |
| postextubation after 15 minutes |
| 30 minutes after extubation |