Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Patients
2.2. Interventions
2.3. Data Collection
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Neurocognitive Function
3.2. Secondary Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
References
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Intervention Group | Control Group | p-Value | ||
---|---|---|---|---|
n | 30 | 30 | ||
Age | years | 70 (63–73) | 64 (67–72) | 0.76 |
Female sex | n (%) | 5 (17) | 9 (30) | 0.36 |
Body Mass Index | kg/m² | 27 (26–29) | 27 (25–28) | 0.6 |
Right-handedness | n (%) | 30 (100) | 28 (93.3) | 0.49 |
School education > 12 years | n (%) | 19 (63.3) | 9 (30) | 0.02 * |
Comorbid conditions | ||||
chronic arterial hypertension | n (%) | 27 (90) | 27 (90) | 1 |
congestive heart failure | n (%) | 8 (26.7) | 9 (30) | 1 |
diabetes mellitus II | n (%) | 7 (23.3) | 10 (33.3) | 0.57 |
chronic kidney disease | n (%) | 1 (3.3) | 2 (6.7) | 1 |
chronic obstructive pulmonary disease | n (%) | 1 (3.3) | 1 (3.3) | 1 |
Antihypertensive drugs | ||||
ACE-inhibitor/sartan | n (%) | 17 (56.7) | 23 (76.7) | 0.17 |
calcium channel blocker | n (%) | 16 (53.3) | 15 (50) | 1 |
central antihypertensive | n (%) | 10 (33.3) | 7 (23.3) | 0.57 |
diuretic | n (%) | 9 (30) | 16 (53.3) | 0.12 |
beta-blocker | n (%) | 9 (30) | 14 (46.7) | 0.29 |
alpha-blocker | n (%) | 2 (6.7) | 1 (3.3) | 1 |
ASA physical status | 3 (3–3) | 3 (3–3) | 0.33 | |
III | n (%) | 30 (100) | 29 (96.7) | 1 |
IV | n (%) | 0 (0) | 1 (3.3) | |
NASCET stenosis grade | ||||
side of surgery | % | 80 (71–90) | 85 (80–90) | 0.35 |
contralateral side | % | 30 (0–50) | 45 (3–54) | 0.32 |
Symptomatic stenosis | n (%) | 11 (37) | 16 (53.3) | 0.3 |
Montreal Cognitive Assessment test | points | 25 (24–27) | 25 (24–27) | 0.82 |
Trail marking test A | s | 50 (37–69) | 61 (48–80) | 0.6 |
Trail marking test B | S | 110 (81–186) | 147 (120–192) | 0.42 |
Month backward test | s | 32 (20–50) | 36 (24–75) | 0.23 |
Breath Holding Index | ||||
side of surgery | 80 (71–90) | 85 (80–90) | 0.52 | |
contralateral side | 29 (0–50) | 45 (3–54) | 0.14 |
Intervention Group | Control Group | ||||||
---|---|---|---|---|---|---|---|
n = 30 | n = 30 | ||||||
Type of Complication | n (%) | Postop Day | Management | Type of Complication | n (%) | Postop Day | Management |
Arterial hypertension * | 1 (3.3%) | Rebleeding | 3 (10%) | ||||
Patient 1 | 2 | Antihypertensive | Patient 1 | 1 | surgical revision | ||
therapy | |||||||
Patient 2 | 1 | surgical revision | |||||
Patient 3 | 1 | surgical revision | |||||
Arterial hypertension * | 3 (10%) | ||||||
Patient 1 | 2 | antihypertensive therapy | |||||
Patient 2 | 3 | antihypertensive therapy | |||||
Patient 3 | 2 | antihypertensive therapy | |||||
Unstable angina | 1 (3.3%) | ||||||
Patient 1 | 2 | anti-ischemic, antihypertensive therapy | |||||
New neurological deficit | 1 (3.3%) | ||||||
Patient 1 | 0 | symptomatic care as per stroke protocol |
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Tomić Mahečić, T.; Malojčić, B.; Tonković, D.; Mažar, M.; Baronica, R.; Juren Meaški, S.; Crkvenac Gregorek, A.; Meier, J.; Dünser, M.W. Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial. J. Clin. Med. 2023, 12, 4885. https://doi.org/10.3390/jcm12154885
Tomić Mahečić T, Malojčić B, Tonković D, Mažar M, Baronica R, Juren Meaški S, Crkvenac Gregorek A, Meier J, Dünser MW. Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial. Journal of Clinical Medicine. 2023; 12(15):4885. https://doi.org/10.3390/jcm12154885
Chicago/Turabian StyleTomić Mahečić, Tina, Branko Malojčić, Dinko Tonković, Mirabel Mažar, Robert Baronica, Snježana Juren Meaški, Andrea Crkvenac Gregorek, Jens Meier, and Martin W. Dünser. 2023. "Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial" Journal of Clinical Medicine 12, no. 15: 4885. https://doi.org/10.3390/jcm12154885