The effect of intravenous anesthesia on postoperative cognitive function in patients undergoing painless gastroscopy:...

With the development of comfortable medical care, the application of intravenous anesthesia in painless gastroscopy is becoming increasingly widespread. However, anesthetic drugs may have adverse effects on postoperative cognitive function, and the risk of postoperative cognitive dysfunction (POCD) is particularly worthy of attention in the elderly population. Our aim is to evaluate the effect of intravenous anesthesia on postoperative cognitive function (POCF) in patients undergoing painless gastroscopy, with a focus on identifying potential risks of POCD and guiding clinical anesthesia practices.

Analyzing randomized controlled trials (RCTs) published in English that assessed the impact of intravenous anesthesia on POCF in patients over 60 years old undergoing elective gastrointestinal endoscopy. The literature search spanned databases including PubMed、Embase、Web of Science、Scopus、Cochrane, and Clinical Key. Study inclusion and exclusion criteria were rigorously defined, and the Cochrane bias risk assessment tool was utilized to evaluate study quality. Meta-analyses were performed using RevMan 5.3, with heterogeneity assessed via I-square statistics.

From a total of 432 articles identified, 7 studies involving 219 patients met the inclusion criteria. The meta-analysis revealed no significant difference in the incidence rates of POCD on Day 1 and Day 3 postoperatively between patients undergoing intravenous versus inhalation anesthesia. However, on Day 7, the incidence of POCD was significantly lower in the intravenous anesthesia group, with a combined Odds Ratio (OR) of 0.96 (95% Confidence Interval (CI): 0.73-1.26, I^2 = 34%, n = 7, P < 0.00001). Furthermore, plasma levels of S-100β protein, a marker for neural injury, were significantly lower in the intravenous anesthesia group, with a Mean Difference (MD) of 0.34 (95% CI: 0.23-0.48, I^2 = 0%, n = 5, P < 0.00001).

Intravenous anesthesia for painless gastroscopy appears to be associated with a lower incidence of POCD on Day 7 postoperatively, suggesting a potentially reduced risk of early postoperative cognitive decline compared to inhalation anesthesia. The findings indicate that intravenous anesthesia may be preferable in minimizing the risk of POCD, particularly in older adults undergoing painless gastroscopy. However, further high-quality, large-scale RCTs are warranted to validate these results and explore the effects across different patient demographics.