question: OBJECTIVE To explore the effect of using regional cerebral oxygen saturation (rScO2) monitoring with near-infrared spectroscopy in peri-anesthesia management of elderly hypertensive patients undergoing shoulder arthroscopic surgery. METHODS Sixty elderly patients with hypertension undergoing shoulder arthroscopic surgery under general anesthesia were enrolled as the research objects for this prospective study, and they were randomly divided into an observation group and a control group. The observation group received bispectral index (BIS) + rScO2, while the control group only adopted BIS. The changes in BIS, mean arterial pressure (MAP), heart rate (HR), and rScO2 at 5 min after intubation (T1), 10 min after intubation (T2), immediately after changing position (T3), 5 min after changing position (T4), and 10 min after changing position (T5) of the two groups were recorded. The correlation between MAP and rScO2 was analyzed. Preoperative and postoperative Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA) scores, serum neuron-specific enolase (NSE) and s100β levels were compared between the two groups. The incidence of postoperative cognitive dysfunction (POCD) at 1-3 days was recorded. RESULTS There were no significant differences in BIS, MAP, HR, or rScO2 between the two groups at T1 and T2 (all P>0.05). At T3-T5, the levels of BIS, MAP, HR, and rScO2 in the two groups decreased, and the control group had lower levels of the above indicators (all P<0.05). Correlation analysis showed that MAP and rScO2 levels were positively correlated in the two groups (r>0, P<0.05). There were no significant differences in the MMSE or MoCA scores, NSE or s100β levels between the two groups before surgery (all P>0.05). After surgery, the MMSE and MoCA scores of the two groups were decreased (both P<0.05), while the NSE and s100β levels were increased (both P<0.05). The control group showed greater changes in the above four indexes (all P<0.05). The incidence of POCD in the observation group was lower than that of controls at 1, 2, and 3 days after surgery (all P<0.05). CONCLUSION rScO2 monitoring with near-infrared spectroscopy in peri-anesthesia management of elderly patients with hypertension undergoing shoulder arthroscopic surgery can effectively stabilize hemodynamics and reduce the incidence of postoperative POCD.