In older patients having surgery, postoperative delirium (an acute disturbance in awareness, attention, or cognition) is common and associated with short-term and long-term morbidity and mortality. The pathophysiology of postoperative delirium is multifactorial - but presumably includes inadequate brain perfusion during surgery caused by low intraoperative blood pressure. Therefore, the investigators aim to determine in a multicenter randomized-controlled trial if targeted intraoperative blood pressure management reduces postoperative delirium. The investigators will test the primary hypothesis that maintaining intraoperative mean arterial pressure at 85 mmHg or higher - compared to at 65 mmHg or higher (routine care) - reduces the incidence of postoperative delirium within the first 3 postoperative days in older patients with arterial hypertension having non-cardiac surgery. The investigators will also assess the duration of postoperative delirium, postoperative complications, and the patients' quality of life. The results of this trial will have a direct impact on guidelines and will help improve medical care for patients and the patients' health. Effective strategies to prevent postoperative delirium are missing. The hypothesis that targeted intraoperative blood pressure management can help reduce postoperative delirium is supported by previous observational studies and interventional trials. This trial is supposed to confirm the causal relationship between intraoperative blood pressure and postoperative delirium and to demonstrate the effectiveness of the therapeutic approach.
Inclusion Criteria:
To be eligible for trial inclusion, patients must:
Exclusion Criteria:
Patients that meet one or more of the following exclusion criteria cannot participate in the trial:
k.kouz@uke.de+4940741052415
Patients, outcome assessors, outcome adjudicators, and data analysts will be blinded to treatment allocation.
In patients assigned to the intervention group, clinicians will be instructed to maintain MAP at 85 mmHg or higher. The trial intervention will start at the beginning of induction of general anesthesia and end at the end of surgery.
In patients assigned to the control group, clinicians will be instructed to maintain MAP at 65 mmHg or higher. The trial intervention will start at the beginning of induction of general anesthesia and end at the end of surgery.
b.saugel@uke.de+4940741052415
Effect of High vs. Low MAP Levels on Clinical Outcomes in Elderly Patients During Noncardiothoracic Surgery
Cerebral Autoregulation and Delirium Study
Target Hemodynamics and Brain Injury During General Anesthesia in the Elderly
Optimized Anesthesia to Reduce Postoperative Cognitive Impairment in the Elderly
Anaesthetic Depth and Short Term Delirium Post Cardiac Surgery Intervention
Perioperative Individualized Optimization of Mean Arterial Pressure in Cardiac Surgery
Postoperative Cognitive Dysfunction in Geriatric Patients
Avoidance of Delirium in Older Patients After Major Non-cardiac Surgery