Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction in the elderly. A randomized controlled...

Area of Science:

• Anesthesiology
• Geriatric Medicine
• Neuroscience

Background:

• Postoperative cognitive dysfunction (POCD) significantly impacts elderly patients' quality of life.
• POCD can be a short-term or long-term disorder.
• Understanding anesthetic effects on cognition is crucial for geriatric surgery.

Purpose of the Study:

• To compare short- and long-term cognitive function after propofol versus sevoflurane anesthesia in elderly patients.
• To investigate the role of the inflammatory process in postoperative cognitive dysfunction.

Main Methods:

• Prospective randomized controlled trial involving 60-74 year olds undergoing >2-hour non-cardiac surgery.
• Patients received either propofol or sevoflurane anesthesia.
• Cognitive function assessed using Mini Mental State Examination (MMSE) at 48 hours and 10 psychometric tests at 9 months. Inflammation assessed via SIRS and inflammatory markers.

Main Results:

• Sevoflurane anesthesia led to a significant decrease in postoperative MMSE scores.
• Nine months postoperatively, sevoflurane patients showed test performance decline.
• Increased inflammatory markers were observed in both groups, with no significant between-group difference except for CRP.

Conclusions:

• Sevoflurane anesthesia has a negative influence on both early and late postoperative cognitive status in the elderly.
• Inflammatory markers did not demonstrate a direct relationship with the patients' cognitive status.
• Propofol may be a preferred anesthetic agent for preserving cognitive function in geriatric surgical patients.