Discussion
cerebrovascular insufficiency, neuroapoptosis, cerebral hypoperfusion, stroke, POCD, hypotensive, cognitive domain
CEREBROVASCULAR INSUFFICIENCY, NEURODEGENERATION, STROKE, BRAIN, HYPOTENSIVE, CORTEX
Since deliberate hypotensive anesthesia is appropriate for patients who will undergo certain surgical procedures, including septoplasty surgery[In the presence of contradictions in the results of previous studies, whether or not hypotensive anesthesia causes POCD [It is well-established that temporal lobe structures, especially the CA1 region of the hippocampus, are one of the most susceptible brain regions to cerebral hypoperfusion [Noteworthy, the results of neuropsychological tests might be confounded by some participant-related factors, including educational level, emotional state, and visual/auditory functions [As far as we know, this study is the first to investigate the effect of deliberate hypotensive anesthesia on Event-related potentials. Brain regions, such as the frontal cortex and the hippocampus, generate the P300 wave [Information processing speed is another cognitive domain commonly affected in POCD other than memory [Cerebral autoregulation is a compensatory mechanism that maintains cerebral blood flow constant despite a change in cerebral perfusion pressure (CPP) due to the effect of hypotensive agents on systemic vascular resistance [It has to be mentioned that the reported POCD in our study may be attributed to the use of general anesthetic drugs. There is strong evidence suggesting the implication of general anesthetics in developing POCD. General anesthetics such as propofol and isoflurane were reported to cause neurodegeneration, neuroapoptosis, caspase activation, and B- amyloid protein accumulation, leading to POCD [Previous studies claimed that nitroglycerin causes an increase in ICP [Whereas nitroglycerin is used broadly in multiple clinical practices in neurological and stroke intensive care units, our study implores limiting its use in anesthesia in neurologically affected patients, especially old age patients with cerebrovascular insufficiency giving chances to other hypotensive drugs in those patients.Lastly, it should be noted that the relatively small sample size and cognitive follow-up for a relatively short period are the most critical limitations of the current study. Further studies with larger sample sizes and more extended follow-up periods are warranted.