Abstract
Postoperative cognitive dysfunction (POCD) increases morbidity and mortality. The mechanisms underlying POCD remain elusive; however, systemic responses induced by anesthesia and surgery might trigger neuroinflammation and POCD. Desflurane is a preferable volatile anesthetic agent for elderly patients because it facilitates shorter recovery from general anesthesia. The aim of this study was to determine whether quality of emergence and cognitive function in elderly patients undergoing a long duration desflurane anesthesia are better than those in the case of sevoflurane anesthesia. Forty-two patients who were older than 65 years of age and scheduled for surgery of more than 4 h in duration were enrolled in this study. Patients were randomly assigned to a desflurane anesthesia group (D group) and sevoflurane anesthesia group (S group). General anesthesia was maintained with 3.5 % desflurane (D group) and 1.0 % sevoflurane (S group). The Mini-Mental State Examination (MMSE) was used for assessing cognitive function 24 h before and after surgery. Postoperative MMSE score in the D group was significantly improved compared to that in the preoperative period. In conclusion, elderly patients undergoing desflurane anesthesia have significantly better quality of emergence and may have better cognitive function than those in elderly patients undergoing sevoflurane anesthesia.
References
Xu T, Bo L, Wang J, Zhao Z, Xu Z, Deng X, Zhu W. Risk factors for early postoperative cognitive dysfunction after non-coronary bypass surgery in Chinese population. J Cardiothorac Surg. 2013;8:204–9.
Cibelli M, Fidalgo AR, Terrando N, Ma D, Monaco C, Feldmann M, Takata M, Lever IJ, Nanchahal J, Fanselow MS, Maze M. Role of interleukin-1beta in postoperative cognitive dysfunction. Ann Neurol. 2010;68:360–8.
Vlisides P, Xie Z. Neurotoxicity of general anesthetics: an update. Curr Pharm Des. 2012;18:6232–40.
Istaphanous GK, Howard J, Nan X, Hughes EA, McCann JC, McAuliffe JJ, Danzer SC, Loepke AW. Comparison of the neuroapoptotic properties of equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in neonatal mice. Anesthesiology. 2011;114:578–87.
Chan MT, Cheng BC, Lee TM, Gin T, CODA Trial Group. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33–42.
Magni G, Rosa IL, Melillo G, Savio A, Rosa G. A comparison between sevoflurane and desflurane anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth Analg. 2009;109:567–71.
Boisson-Bertrand D, Laxenaire MC, Mertes PM. Recovery after prolonged anaesthesia for acoustic neuroma surgery: desflurane versus isoflurane. Anaesth Intensive Care. 2006;34:338–42.
Jones RM, Cashman JN, Eger EI 2nd, Damask MC, Johnson BH. Kinetics and potency of desflurance (I-653) in volunteers. Anesth Analg. 1990;70:3–7.
Mutoh T, Taki Y, Tsubone H. Desflurane but not sevoflurane augments laryngeal C-fiber inputs to nucleus tractus solitarii neurons by activating transient receptor potential-A1. Life Sci. 2013;92:821–8.
McKay RE, Malhotra A, Cakmakkaya OS, Hall KT, McKay WR, Apfel CC. Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane. Br J Anaesth. 2010;104:175–82.
Malloy PF, Cummings JL, Coffey CE, Duffy J, Fink M, Lauterbach EC, Lovell M, Royall D, Salloway S. Cognitive screening instruments in neuropsychiatry: a report of the committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 1997;9:189–97.
Chen X, Zhao M, White PF, Li S, Tang J, Wender RH, Sloninsky A, Naruse R, Kariger R, Webb T, Norel E. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg. 2001;93:1489–94.
Bailey JM. Context-sensitive half-times and other decrement times of inhaled anesthetics. Anesth Analg. 1997;85:681–6.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924–34.
Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.
Ebert TJ, Trotier TS, Arain SR, Uhrich TD, Barney JA. High concentrations of isoflurane do not block the sympathetic nervous system activation from desflurane. Can J Anaesth. 2001;48:133–8.
Muzi M, Lopatka CW, Ebert TJ. Desflurane-mediated neurocirculatory activation in humans. Effects of concentration and rate of change on responses. Anesthesiology. 1996;84:1035–42.
Kaur A, Jain AK, Sehgal R, Sood J. Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery. J Anaesthesiol Clin Pharmacol. 2013;29:36–40.
Hovens IB, Schoemaker RG, van der Zee EA, Absalom AR, Heineman E, van Leeuwen BL. Postoperative cognitive dysfunction: involvement of neuroinflammation and neuronal functioning. Brain Behav Immun. 2014. [Epub ahead of print].
Loepke AW, Priestley MA, Schultz SE, McCann J, Golden J, Kurth CD. Desflurane improves neurologic outcome after low-flow cardiopulmonary bypass in newborn pigs. Anesthesiology. 2002;97:1521–7.
Dimaculangan D, Bendo AA, Sims R, Cottrell JE, Kass IS. Desflurane improves the recovery of the evoked postsynaptic population spike from CA1 pyramidal cells after hypoxia in rat hippocampal slices. J Neurosurg Anesthesiol. 2006;18:78–82.
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This work was financially supported by Baxter US.
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Tachibana, S., Hayase, T., Osuda, M. et al. Recovery of postoperative cognitive function in elderly patients after a long duration of desflurane anesthesia: a pilot study. J Anesth 29, 627–630 (2015). https://doi.org/10.1007/s00540-015-1979-y
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DOI: https://doi.org/10.1007/s00540-015-1979-y