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

Apr 5, 2017Journal of clinical anesthesia

Effects of Propofol, Sevoflurane, and Isoflurane on Memory and Thinking Problems After Gallbladder Surgery in Older Adults

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Abstract

The incidence of postoperative cognitive dysfunction (POCD) was significantly lower in the propofol group compared to both the isoflurane and sevoflurane groups.

POCD incidence at postoperative day 1 and day 3 was significantly reduced for propofol versus isoflurane (P<0.001) and versus sevoflurane (D1: P=0.012; D3: P=0.013).
Sevoflurane also showed a lower incidence of POCD compared to isoflurane at day 1 (P=0.041), but not at day 3.
Postoperative plasma levels of S-100β, Aβ protein, IL-1β, IL-6, and TNF-α were significantly lower in the propofol group compared to the isoflurane group.

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STUDY OBJECTIVE: 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.

DESIGN: Prospective, randomized, double-blind clinical trial.

SETTING: University-affiliated teaching hospital.

PATIENTS: One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy.

INTERVENTIONS: 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 Aβprotein, 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. 1-40

MAIN RESULTS: 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 Aβprotein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. 1-40

CONCLUSIONS: Propofol anesthesia may be an option for elderly surgical patients.

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

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