Effect of propofol,sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial |
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| Institution: | 1. Department of Anesthesiology, Second Affiliated Hospital, Harbin Medical University, Nangang District of Harbin, Harbin, China;2. Department of Anesthesiology, The First Hospital of Putian City, Putian, China;1. Ministry of Health, Y?ld?r?m Beyaz?t Training Hospital, Ankara, Turkey;2. TDV 29 May?s Hospital, Ankara, Turkey;3. Çankaya Hospital, Ankara, Turkey;4. Gülhane Military Medical Academy, Ankara, Turkey;5. Yüksek ?htisas Hospital, Ankara, Turkey;6. International Medicana Hospital, Ankara, Turkey;7. Haydarpa?a Military Training Hospital, ?stanbul, Turkey;8. Güven Hospital, Ankara, Turkey;1. Department of Anesthesiology, Zhejiang Provincial People''s Hospital, People''s Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China;2. Department of Orthopedics, Zhejiang Provincial People''s Hospital, People''s Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China;3. Department of Pharmacy, Hangzhou Third Hospital, 38 West Lake Avenue, Hangzhou 310009, Zhejiang Province, China |
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| Abstract: | Study objectiveTo compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (> 60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population.DesignProspective, randomized, double-blind clinical trial.SettingUniversity-affiliated teaching hospital.PatientsOne hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy.InterventionsElderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day 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 1 h (T2) and 24 h (T3) postoperatively.Main resultsThe 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.ConclusionsPropofol anesthesia may be an option for elderly surgical patients. |
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