Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction in the elderly. A randomized controlled trial.

ABSTRACT

BACKGROUND: Postoperative cognitive dysfunction is a topic of special importance in the geriatric surgical population which primarily resolves within the short term postoperative period, but it can become a long term disorder with significant impact on patient's quality of life. This study was designed to compare the short and long term postoperative cognitive function after propofol and sevoflurane anaesthesia in the elderly and to evaluate the role of the inflammatory process. METHODS: Patients, aged 60-74, scheduled for a non-cardiac operation of more than two-hour duration were enrolled in this prospective randomized controlled trial and allocated into two groups in order to receive propofol or sevoflurane anaesthesia. Postoperative early cognitive function was assessed by means of the Mini Mental State Examination test (MMSE) 48 hours postoperatively. Late cognitive function was evaluated by means of 10 psychometric tests, 9 months postoperatively. The role of inflammation was estimated by the incidence of SIRS and the levels of the inflammatory markers. RESULTS: Statistical significant decrease was observed in the postoperative MMSE values in the sevoflurane group. Nine months postoperatively, there was a decline in test performance in the same group and an increase in postoperative values of inflammatory markers in both groups, which turned non-significant in their between comparison (except CRP). CONCLUSION: According to the neuropsychological test evaluation of cognition, there is a negative influence of sevoflurane anaesthesia on the early and late postoperative state. As far as the inflammatory markers are concerned, they don't relate to the patient's cognitive status.