Awareness of controlled hypotension and its neurocognitive risks among otorhinolaryngology surgeons: a descriptive cross-sectional survey study

Aims: Controlled hypotension (CH) is widely used in otorhinolaryngology (ENT) surgery to minimize bleeding and improve the surgical field of view. The aim of this study is to investigate the hemodynamic monitoring habits of ENT specialists and residents during CH, their targeted lower blood pressure limits, and their awareness of potential neurocognitive risks such as postoperative cognitive dysfunction (POCD). Methods: This prospective, descriptive, and cross-sectional study was conducted in May 2026 with the participation of 91 ENT physicians (48 specialists, 43 residents) practicing across Turkiye. Data were collected using an original 13-item online survey evaluating demographic characteristics, CH knowledge level, quantitative blood pressure targets, POCD awareness, and inter team communication approaches. Pearson Chi-square, Fisher's exact, and Mann-Whitney U tests were used for data comparison; p<0.05 was considered statistically significant. The estimated response rate was 9.1%, which may indicate a potential selection bias. Results: It was determined that 70.3% of the participating physicians correctly defined CH based on mean arterial pressure (MAP). However, in practical application, surgeons' hemodynamic reference preferences were divided into systolic blood pressure (SBP) (47.3%) and MAP (47.3%). Among those tracking SBP, 55.8% targeted <90 mmHg, while 32.6% of those monitoring MAP targeted <70 mmHg. When POCD awareness levels were compared, specialists (median: 3) were found to be significantly more aware than residents (median: 2) (p<0.001). 79.1% of the residents reported low POCD awareness (score ≤2). The majority of participants (79.1%) stated they supported routine preoperative briefings where the patient's neurocognitive reserve is also discussed. Conclusion: In their requests for controlled hypotension, ENT surgeons frequently reference SBP instead of MAP, which is the actual indicator of tissue perfusion, and they may target thresholds that can strain the limits of cerebral autoregulation. The low POCD awareness detected among resident physicians highlights a potential educational gap regarding perioperative patient safety. The integration of cerebral perfusion training into ENT residency curricula and the routinization of MAP-targeted multidisciplinary briefings before surgery are recommended to minimize these risks.