Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis

Abstract

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, ie, evaluations up to 30 days postoperative, and neurocognitive disorder, ie, assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1913 articles yielded ten studies with a total of 3390 individuals. For the secondary objective, four studies with a total of 480 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.46 (95% CI = 0.26–0.81; p = 0.01), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Given the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.

Prospective comparison of three methods for detecting peri‐operative neurocognitive disorders in older adults undergoing cardiac and non‐cardiac surgery

“…A time interval of 4-8 weeks was chosen for which the postoperative tests could be taken. This was because the incidence of postoperative neurocognitive disorders at one postoperative month is almost identical to that at three postoperative months [31,35], but it is possible that a small group of patients suffered from transient cognitive decline not diagnosed before postoperative testing. The incidence of postoperative neurocognitive disorders could therefore have been underestimated.…”

Safety and efficacy of etomidate in combination with oxycodone in painless gastroscopic procedures in the elderly: A prospective randomized controlled trial study

“…[4,6,8,11,16] Postoperative cognitive dysfunction refers to changes in orientation, thinking, memory, attention, and other cognitive abilities in patients undergoing surgical anesthesia who have no preoperative psychiatric abnormalities. [17] The occurrence of postoperative cognitive dysfunction can impair recovery, prolong hospital stay and even affect the quality of life after discharge. [18,19] The elderly and the anesthesia technology are independent risk factors for the occurrence of postoperative cognitive dysfunction.…”

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

“…The long-term effects of propofol on cognitive function warrant further study. Although propofol anesthesia may cause a certain degree of cognitive impairment in the short term, it is far less than inhalation anesthesia (Hou and Xiao, 2019;Negrini et al, 2022). A meta-analysis comparing the effects of propofol and sevoflurane anesthesia on the postoperative cognitive function of elderly patients with lung cancer (>60 years old) suggested that propofol yields more adverse effects on the cognitive function of elderly patients with lung cancer than sevoflurane (Sun et al, 2019).…”