Comparison of postoperative cognitive functions between total intravenous anesthesia and inhaled anesthesia in elderly patients

Objective To compare the postoperative cognitive functions between total intravenous anesthesia and inhaled anesthesia in elderly patients.Methods Sixty elderly patients(aged over 65-year-old,American Society of Anesthesiologists Ⅰ-Ⅲ)undergoing elective abdominal surgery were randomly assigned to three groups(n=20,each group).Patients in group T received total intravenous anesthesia with remifentanil and propoful;patients in group I and group S received inhaled isoflurane or sevoflurane anesthesia,respectively.Postoperative intravenous patient-controlled analgesia was applied to all patients.Hemodynamic parameters(mean artery pressure,heart rate)were monitored.Anesthesia and operation durations,time of spontaneous eye opening and extubation,the amount of fluid volume and blood transfusion,blood lost during the operation were also recorded.Cognitive function was assessed before operation and at 1,3,6,24 hours after operation by using mini-mental state examination(MMSE).Results There were no significant differences in age,gender,body weight,duration of anesthesia and surgery,blood loss,liquid and blood transfusion among the three groups(all P0.05).Hemodynamic parameters were similar among groups(all P0.05).The time to spontaneous eye opening and extubation in group T were significantly shorter than that in group I and group S(P0.05).MMSE scores were similar preoperatively and 24 h after operation among the three groups(P0.05)while MMSE scores were significantly lower in all groups at 1 h after operation than those after operation(P0.05)and reached the preoperative level at 3 h in group T,at 6 h in group S,at 24 h in group I.Conclusion All three anesthetic methods can lead to short-term cognitive dysfunction in elderly patients.Patients undergoing intravenous anesthesia with remifentanil and propofol could recover from postoperative cognitive dysfunction(POCD)faster than inhalation anesthesia.POCD induced by sevoflurane is less than that by isoflurane.