Inhalation Versus Total Intravenous Anesthesia: A Literature Review

Abstract

Postoperative delirium, an acute condition characterized by reduced awareness of the environment and disturbance in attention, usually occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients. Postoperative cognitive dysfunction (POCD) is a new onset of cognitive impairment that may persist for weeks or months after surgery. The primary objective of this study was to review the literature on the clinical impact of the choice of general anesthesia on the incidence of POCD, whether inhaled or total intravenous anesthesia in the first 30 days, excluding assessments on the same day of surgery. In conclusion, total intravenous anesthesia may be associated with a lower incidence of POCD, compared to inhalational anesthesia, at least in the first 30 postoperative days. However, future studies investigating POCD must focus on assessments of attention because the validity of testing all other cognitive subdomains (for example: memory, executive functions) depends on their integrity. This could also reduce heterogeneity in POCD research.