Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial.|
Sun, Sheng-Hui; Yang, Lin; Sun, De-Feng; Wu, Yue; Han, Jun; Liu, Ruo-Chuan & Wang, Li-Jie
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
Nicardipine; esmolol; nitroglycerin; hemodynamics; post-operative cognitive dysfunction