Comparison of the effects of hypotensive anesthesia techniques based on systolic and mean arterial pressure on cerebral perfusion, blood oxidant-antioxidant levels and HIF-1a levels

Purpose: This study aims to compare and evaluate changes in tissue and cerebral perfusion when systolic blood pressure (SBP) or mean arterial pressure (MAP) is used as the reference parameter to achieve controlled hypotension. Materials and Methods: Patients scheduled for planned rhinoplasty or jaw surgery requiring controlled hypotension were included in the study. The patients were categorized into two groups: Group 1 (systolic blood pressure group) and Group 2 (mean arterial pressure group). Before anesthesia induction and emergence, levels of total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and hypoxia-inducible factor (HIF-1α) in the blood were measured. Perioperative cerebral perfusion monitoring was performed using near-infrared spectroscopy (NIRS). Results: There was no significant difference between the two groups in preoperative and postoperative levels of TAS, TOS, OSI, and HIF-1α, which are used as indicators of oxidative stress. Similarly, there was no significant difference in RsO2 values between the groups. Surgical satisfaction scores were significantly higher in Group 2, while bleeding scores were significantly lower. Conclusion: MAP-targeted controlled hypotension provides higher surgical satisfaction and lower bleeding scores without causing disadvantages in terms of cerebral oxygenation or oxidative stress.