Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial.

BACKGROUND AND OBJECTIVES: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.

Oxidant/Antioxidant Status of Breast Cancer Patients in Pre- and Post-Operative Periods.

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the level of oxidative stress before and after breast cancer surgery. MATERIALS AND METHODS: Malondialdehyde (MDA) level was tested using a thiobarbituric acid (TBA) assay based on the release of a color complex due to TBA reaction with MDA. The glutathione S-transferase (GST) activity was evaluated by enzymatic conjugation of reduced glutathione (GSH) with 1-chloro-2,4-dinitrobenzene. The level of total glutathione (reduced GSH and oxidized GSSG) was detected using a recycling system by 5,5-dithiobis(2-nitrobenzoic acid). The levels of the indices were determined in the serum of 52 patients before surgery, two hours and five days after surgery, and in 42 healthy women. RESULTS: In the patients over 50 years old the level of MDA was higher after surgery in comparison with before surgery, and GST activity was lower in comparison with the control. The GSH + GSSG level in both ages groups after surgery was lower than in the control. Significant differences of MDA level were detected in patients with stage III after surgery compared to the control. The level of GSH + GSSG was significantly lower in the patients with I-III stages compared to the control. CONCLUSION: The most expressed changes demonstrate the significance of MDA as a marker to evaluate oxidative stress in breast cancer patients. The degree of oxidative stress depends on the patient's age and stage of disease.

Effects of sevoflurane and desflurane on early cognitive changes after thyroid surgery: interim results.

The study is being conducted at the 1st Department of Anaesthesiology, the Centre of Abdominal Surgery, the Centre of Anaesthesiology, Intensive Care and Pain Management of Vilnius University Hospital Santaros Klinikos. BACKGROUND: These are primary results of a randomized double-blinded study comparing postoperative changes in cognitive functions and the effect of desflurane and sevoflurane on these changes. MATERIALS AND METHODS: The study includes patients of ≥40 years of age undergoing elective thyroid surgery under general anaesthesia. Patients were randomly allocated to either sevoflurane or desflurane group. Cognitive testing (memory, attention, and reasoning tasks) was performed a day before surgery and repeated 24 hours postoperatively. A decrease of 20% in the postoperative score was considered as postoperative cognitive dysfunction (POCD). RESULTS: At present 38 patients are included in the study. Median decrease in the postoperative score was 2.7% (IQR 16.7). The incidence of POCD was 2.6%. Significantly decreased memory scores were observed in 15.8% of patients. Both study groups were comparable based on demography, duration of anaesthesia, intraoperative opioids, postoperative pain, and satisfaction. No difference was found in the cognitive score comparing sevoflurane and desflurane groups, except for memory tasks where the sevoflurane group performed worse (p = 0.01).The age or the duration of anaesthesia did not affect postoperative scores. Postoperative satisfaction negatively correlated with the memory score (r = -0.35, p = 0.03). Postoperative satisfaction correlated with the reasoning score (r = -0.55; p < 0.01) and the total score (r = -0.42; p = 0.03) in the sevoflurane group. Likewise, temperature in the sevoflurane group correlated with the memory score (r = -0.58; p = 0.02). CONCLUSIONS: The desflurane group performs better in memory tasks, but no such advantage is found in the total cognitive score. In contrast to the age or anaesthesia duration, intraoperative temperature and postoperative satisfaction may affect postoperative cognitive performance.

Comparison of different anesthetic regimens in patients undergoing laparoscopic adjustable gastric banding operations: a prospective randomized trial.

BACKGROUND AND OBJECTIVE: Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations. MATERIAL AND METHODS: In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m(2)), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting. RESULTS: The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3) CONCLUSIONS: Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study.