Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial

Abstract

As life expectancy increases, more patients ≥65 years undergo general anesthesia. Anesthetic agents may contribute to postoperative cognitive dysfunction, and incidence may differ with anesthetic agents or intraoperative anesthesia depth. Responses to anesthetic adjuvants vary among elderly patients. Processed electroencephalography guidance of anesthetic may better ensure equivalent cerebral suppression. This study investigates postoperative cognitive dysfunction differences in elderly patients given desflurane or sevoflurane using processed electroencephalography guidance.IRB approved, randomized trial enrolled consenting patients ≥65 years scheduled for elective surgery requiring general anesthesia ≥120 minute duration. After written informed consent, patients were randomly assigned to sevoflurane or desflurane. No perioperative benzodiazepines were administered. Cognitive impairment was measured by an investigator blinded to group assignment using mini-Mental Status Examination (MMSE) at baseline; 1, 6, and 24 hours after the end of anesthesia. Mean arterial pressure was maintained within 20% of baseline. Anesthetic dose was adjusted to maintain moderate general anesthesia per processed electroencephalograpy (Patient State Index 25 to 50). The primary outcome measure was intergroup difference in MMSE change 1 hour after anesthesia (median; 95% confidence interval).110 patients consented; 26 were not included for analysis (no general anesthesia; withdrew consent; baseline MMSE abnormality; inability to perform postoperative MMSE; data capture failure); 47 sevoflurane and 37 desflurane were analyzed. There were no significant differences in patient characteristics; intraoperative mean blood pressure (desflurane 86.4; 81.3 to 89.6 versus sevoflurane 82.5; 80.2 to 86.1 mmHg; p = 0.42) or Patient State Index (desflurane 41.9; 39.0 to 44.0 versus sevoflurane 41.0; 37.5 to 44.0; p = 0.60) despite a lower MAC fraction in desflurane (0.82; 0.77 to 0.86) versus sevoflurane (0.96; 0.91 to 1.03; p < 0.001). MMSE decreased 1 hour after anesthesia (p < 0.001). The decrease at one hour was larger in sevoflurane (−2.5; −3.3 to −1.8) than desflurane (−1.3; −2.2 to −0.5; p = 0.03). MMSE returned to baseline by 6 hours after anesthesia.ConclusionsFor elderly patients in whom depth of anesthesia is maintained in the moderate range, both desflurane and sevoflurane are associated with transient decreases in cognitive function as measured by MMSE after anesthesia, with clinically insignificant differences between them in this setting.Trial registryClinicalTrials.gov NCT01199913

Comparison of early recovery and cognitive function after desflurane and sevoflurane anaesthesia in elderly patients: A meta-analysis of randomized controlled trials

“…The analysis included only five studies, while three additional related articles were excluded due to inappropriate outcome reporting. 15,17,25 There was significant heterogeneity in the meta-analysis of several recovery events, most likely related to differences in study protocols. In addition, due to the limited number of included studies, it was not possible to perform a funnel plot to test publication bias.…”

“…2 Because of age-related degeneration in respiratory and cardiovascular function and other associated systemic diseases, elderly patients are at risk of experiencing anaesthesia complications. Postoperative cognitive dysfunction (POCD) was found to be present in 25.8% of elderly patients at 1 week after surgery, and 9.9% of elderly patients at 3 months after surgery. 3 In addition, elderly patients who developed POCD were twice as likely to develop dementia in the following 3-7 years after anaesthesia and surgery compared with those unaffected by POCD.…”

Effect of Sugammadex versus Neostigmine/Atropine Combination on Postoperative Cognitive Dysfunction after Elective Surgery

“…an impairment of memory, concentration and intellectual abilities, is a well-known complication after both cardiac and non-cardiac operations [1][2][3][4][5][6] . Various studies have observed that the incidence of this condition ranges from 10% to 65% postoperatively 7,8 and is influenced by factors such as type of surgery 1,[9][10][11][12][13] , the age of patients 14,15 , and the timing of postoperative cognitive examination 1,[15][16][17][18][19][20][21][22][23][24][25][26][27] . Despite extensive investigation [27][28][29][30][31] , firm conclusions that link risk factors to the development and duration of this condition remain elusive.…”

A prospective observational study of the use of desflurane anesthesia in Indian adult inpatients undergoing surgery: The Registry in India on Suprane Emergence registry

“…[45] Besides awareness prevention, use of anesthesia depth monitoring helps avoid anesthetic overdosing, thereby achieving earlier recovery and preventing PONV. [4] Greater intraoperative depth of anesthesia was observed to lead to better postoperative analgesia[67] but could not be confirmed by a study, in which both BIS and ETC of desflurane were measured.…”