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Effects of Goal-Directed Hemodynamic Therapy Using a Noninvasive Finger-Cuff Monitoring Device on Intraoperative Cerebral Oxygenation and Early Delayed Neurocognitive Recovery in Patients Undergoing Beach Chair Position Shoulder Surgery: A Randomized Controlled Trial
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2022-09-22 , DOI: 10.1213/ane.0000000000006200
Chen-Tse Lee, Chih-Peng Lin, Kuang-Cheng Chan, Yi-Luen Wu, Hsiao-Chun Teng, Chun-Yu Wu

hemodynamic therapy (GDHT) would attenuate these conditions. METHODS: We randomly assigned 70 adult patients undergoing BCP shoulder surgery to GDHT group or control at a 1:1 ratio. Cerebral oxygenation was monitored using near-infrared spectroscopy, and GDHT was administered using the ClearSight pulse wave analysis system. The primary outcome was CDE duration, whereas the secondary outcomes were CDE occurrence, delayed neurocognitive recovery occurrence, and Taiwanese version of the Quick Mild Cognitive Impairment (Qmci-TW) test score on the first postoperative day (T2) adjusted for the baseline score (on the day before surgery; T1). RESULTS: CDE duration was significantly shorter in the GDHT group (0 [0–0] vs 15 [0–75] min; median difference [95% confidence interval], −8 [−15 to 0] min; P = .007). Compared with the control group, fewer patients in the GDHT group experienced CDEs (23% vs 51%; relative risk [95% confidence interval], 0.44 [0.22–0.89]; P = .025) and mild delayed neurocognitive recovery (17% vs 40%; relative risk [95% confidence interval], 0.60 [0.39–0.93]; P = .034). The Qmci-TW scores at T2 adjusted for the baseline scores at T1 were significantly higher in the GDHT group (difference in means: 4 [0–8]; P = .033). CONCLUSIONS: Implementing GDHT using a noninvasive finger-cuff monitoring device stabilizes intraoperative cerebral oxygenation and is associated with improved early postoperative cognitive scores in patients undergoing BCP shoulder surgery....
更新日期:2022-09-22
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