Journal Article

Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial

Wu, Qing-hua, Geng, Ying-jie, Zhang, Rui-qin

2017

Overview

To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Prospective, randomized, double-blind clinical trial. University-affiliated teaching hospital. One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Propofol anesthesia may be an option for elderly surgical patients. •Postoperative cognitive dysfunction is commonly occurred in elderly.•Anesthesia impaired the cognitive function.•Propofol had little effect then inhaled anesthetics.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Airway management / Anesthesia / Anesthesia & Perioperative Care / Anesthesia - adverse effects / Anesthesia - methods / Anesthesiology / Anesthetics, Inhalation - administration & dosage / Anesthetics, Inhalation - adverse effects / Anesthetics, Intravenous - administration & dosage / Anesthetics, Intravenous - adverse effects / Apoptosis / Biomarkers - blood / Blood-brain barrier / Cholecystectomy / Cholecystectomy, Laparoscopic - adverse effects / Clinical trials / Cognitive ability / Cognitive Dysfunction - blood / Cognitive Dysfunction - chemically induced / Cognitive Dysfunction - epidemiology / Double-Blind Method / Elderly / Electrocardiography / Female / Heart rate / Humans / Incidence / Intubation / Isoflurane - administration & dosage / Isoflurane - adverse effects / Laparoscopy / Male / Methyl Ethers - administration & dosage / Methyl Ethers - adverse effects / Mortality / Neuropsychological Tests / Pain Medicine / Patients / Pharmaceuticals / Physiology / Postoperative cognitive dysfunction / Postoperative Complications - blood / Postoperative Complications - chemically induced / Postoperative Complications - epidemiology / Propofol - administration & dosage / Propofol - adverse effects / Prospective Studies / Proteins / Risk Factors / Rodents / Time Factors / Trauma