Cervical Cord Compression and Hypertension

Taipei Veterans General Hospital

Status: Unknown

Conditions: Hypertension

Treatments: Procedure: Decompression surgery

Study type: Observational

Funder types: Other

Identifiers

NCT04345822

2019_12_003CC

Details and patient eligibility

About

Myelopathy from cervical cord compression may induce hypertension and sympathetic hyperactivity. Anesthesia may suppress sympathetic activity and lead to hypotension that require vasopressor treatment. We aim to elucidate the causative factors for severe hypotension during anesthesia by prospective observational study.

Full description

It had been reported the cervical spondylotic myelopathy may lead to the development of hypertension. Decompression surgeries ameliorated neurological symptoms as well as the blood pressure. The cause may be the abnormality of autonomic dysfunction developed after myelopathy. However, the evidence was weak. We have noticed a tendency of hypotension during anesthesia in patients undergroing cervical spine surgeries, especially in surgeries of long levels and hypertensive patients. Thus we postulate the autonomic activity is abnormal in patients with cervical myelopathy. Sympathetic hyperactivity developed in order to maintain adequate perfusion to the cervical cord. When patients are under anesthesia, the sympathetic tone is suppressed, thus leading to severe hypotension that require the treatment of inotropic treatment. Heart rate variability (HRV) is a good index of autonomic activity. Thus we plan to Therefore we will measure the HRV (analysis of ECG) and baroreflex activity (analysis of arterial line during the anesthesia) in patients undergoing cervical spine surgeries for decompression of cord compression perioperatively. The primary end-point is the comparison of severity of cord compression between normotensive and hypertensive patients with cervical myelopathy. The secondary end-point is to compare blood pressure and HRV pre- and postoperatively. The third end-point is to elucidate the causative factors for severe hypotension during anesthesia.

Enrollment: 100 estimated patients

Sex: All

Ages: 20 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• cervical spine surgery for cord compression

Exclusion criteria

• spinal cord injury
• ASA class >3
• chronic kidney disease
• congestive heart failure
• BMI>30
• atrial fibrillation/ flutter
• obstructive sleep apnea

Trial design

100 participants in 2 patient groups

normotension

Description:

patients without diagnosis or treatment for hypertension

Treatment:

Procedure: Decompression surgery

hypertension

Description:

patients with diagnosis or treatment for hypertension

Treatment:

Procedure: Decompression surgery