Post-Operative Cognitive Outcomes in Elderly Patients Undergoing General Anesthesia: A Comparison of Inhalational (Sevoflurane) and Total Intravenous (Propofol) Maintenance of Anesthesia

Abstract

Objective: The anaesthetic agent used to maintain anaesthesia may have an effect on postoperative cognitive impairment, however this has not been demonstrated (POCD). The goal of this study was to determine the prevalence of cognitive outcomes postoperatively in patients who were maintained anaesthetized with sevoflurane or propofol throughout total hip replacement surgery.

Methods: To maintain general anaesthesia in patients following spinal anaesthesia, anesthesiologists used sevoflurane (n=121) or propofol (n=171) to keep the processed electroencephalogram (BIS) below 60. A neuropsychological test battery was administered on day 7, three months, and one year after surgery to measure postoperative cognitive disorders.

Results: There were no statistically significant variations in POCD incidence between sevoflurane and propofol at any time point. The mean BIS was considerably lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [SD 7.5] in the sevoflurane group against 53.7 [SD 8.1] in the propofol group, P=0.0001). At any time point, no statistically significant association between BIS levels and the prevalence of POCD was identified.

Conclusion: The anaesthetic used appears to have minimal effect on the occurrence of POCD in older adults.