Blood pressure targets during surgery and thinking ability in cancer patients

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for adults aged 40 to 85 at high risk of stroke who are planning surgery for an abdominal tumor under general anesthesia. It compares two ways of managing blood pressure during surgery.

Age

40 to 85 years

Sex

All sexes can join.

Disease stage

Planned surgery for an abdominal tumor (gynecological, urinary, hepatobiliary or gastrointestinal), expected to last more than 2 hours, under general anesthesia. High stroke risk: 3 or more risk factors on the stroke risk screening table. ASA class II or III.

Earlier treatment

Invasive arterial blood pressure monitoring before surgery. New stroke less than 3 months ago is not allowed.

Main reasons for not taking part

• Severe heart disease or severe liver function impairment (Child-Pugh class C)
• Needs kidney replacement therapy
• New stroke less than 3 months ago
• Emergency surgery
• History of mental illness, epilepsy, Parkinson's disease or myasthenia gravis

The registry criteria, word for word

Check if you might fit

Answer for yourself. This is not a decision: only the study team can say whether you can take part.

• Are you between 40 and 85 years old?YesNo

What the trial wants to find out

This is a randomized controlled study to explore whether perioperative blood pressure management with different strategies can reduce the incidence of delirium and postoperative cognitive impairment and serious perfusion related complications (persistent hypotension, new heart arrhythmia, cardiac insufficiency, new stroke, sudden death, etc.) within 30 days after stroke in cancer patients at high risk for stroke.

The 2 groups in the trial

• Strict Blood Pressure Management Group (MAP > 80 mmHg)Treatment being tested

  Management strategy: For patients assigned to strict blood pressure management, stop taking ACEI (angiotensin converting enzyme inhibitors) or ARB (angiotensin receptor blockers) on the day of surgery. Other antihypertensive drugs can be given selectively depending on the patient's blood pressure level. Intraoperative use of norepinephrine or phenylephrine (norepinephrine 0.01-0.1μg/kg/min or phenylephrine 0.15-1.1 ug/kg/min). The actual infusion speed depends on achieving the target MAP.

  Treatment: Norepinephrine or phenylephrine

• Management strategy of the conventional blood pressure management group (MAP>65mmHgNo study treatment, for comparison

  For patients assigned to the conventional blood pressure management group, ACEI, ARB or calcium antagonists can be used until the morning of the day of surgery if the anesthesiologist deems it necessary. Intraoperative blood pressure management is based on routine, and it is not necessary to use pressor drugs prophylactically, which can be used according to the actual clinical situation. In general, intraoperative MAP should not be lower than 65mmHg. If there is no contraindication of hypotension, oral antihypertensive drugs can be resumed as soon as possible after surgery.