Early Neurocognitive Function With Propofol or Desflurane Anesthesia After Laser Laryngeal Surgery With Low Inspired Oxygen

Abstract

Purpose The effects of general anesthetics on cognitive impairment are unclear and complicated. Laser laryngeal surgery (LLS) requires the administration of low levels of oxygen, which may increase the risk of desaturation and brain function impairment. This prospective randomized trial aimed to compare the effects of desflurane and propofol‐based general anesthesia on the occurrence of early postoperative cognitive decline in elderly patients undergoing LLS. Methods Seventy‐three patients classified as American Society of Anesthesiologists grade I or II and at least 65 years of age were randomly allocated to receive either desflurane‐based (Group D) or propofol‐based (Group P) anesthesia during LLS. The standard anesthesia protocol was performed, with a bispectral index between 40 and 60 and a mean arterial pressure within 20% of baseline values. Intraoperative regional oxygen saturation values were recorded. Each patient was assessed using the mini‐mental state examination (MMSE) test during the preoperative period (baseline), 30 min after extubation in the postanesthesia care unit, and 1, 3, and 24 h after surgery. Results MMSE scores improved slightly in both groups compared to baseline during the early postoperative period, but these increases were not statistically significant. No significant differences were identified in MMSE scores between groups. Only three patients (9.6%) in group D and one patient (3.1%) in group P developed cognitive impairment (p = 0.583). Conclusion Low intraoperative inspired oxygen concentration during short‐duration LLS did not reduce early postoperative cognitive function in elderly patients. Desflurane or propofol‐based anesthesia had similar effects on early neurocognition after LLS. Level of Evidence 2 Laryngoscope, 133:640–646, 2023

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

“…As seen by their lower MMSE scores compared to individuals who did not have delayed neurocognitive recovery, it is interesting to note that these patients had worse cognitive performance ( 29 ). Additionally, these individuals spent longer in the hospital, which is consistent with other findings ( 30 , 31 ). Age, Mini-mental State Examination score, State-anxiety inventory score, Trait-anxiety inventory score, duration of anesthesia, and length of hospital stay were found to be significant predictors of delayed neurocognitive recovery in the analysis of Univariate Logistic regression.…”

The Impact of Total Intravenous Anesthesia Versus Inhalational Anesthesia on Postoperative Cognitive Dysfunction in Elderly Patients

“…TIVA has been suggested to have potential neuroprotective effects. Studies have demonstrated that some intravenous agents, like propofol, may reduce the inflammatory response and oxidative stress in the brain, potentially minimizing the risk of POCD (Qiao et al, 2023). Inhalational agents like desflurane and sevoflurane, on the other hand, have been associated with neuroinflammation and oxidative stress, possibly increasing the risk of cognitive dysfunction.…”