Association Between Anesthetics and Postoperative Delirium in Elderly Patients Undergoing Spine Surgery: Propofol Versus Sevoflurane

Abstract

Study designs Retrospective Observational Study Objectives: To compare the incidence of POD after propofol- and sevoflurane-based anesthesia in elderly patients undergoing spine surgery. Methods In this study, the medical records of elderly patients ≥ 65 years of age who underwent spine surgery under total intravenous anesthesia with propofol or inhalational anesthesia with sevoflurane were reviewed. The primary outcome was the incidence of POD after propofol- and sevoflurane-based anesthesia. Secondary outcomes included postoperative 30-day complications, length of postoperative hospital stay, associations of patient characteristics, and surgery- and anesthesia-related data with the development of POD, and associations of anesthetics with clinical outcomes such as postoperative 30-day complications, and length of postoperative hospital stay. Results Of the 281 patients, POD occurred in 29 patients (10.3%). POD occurred more frequently in the sevoflurane group than in the propofol group (15.7% vs. 5.0%, respectively; P=.003). The multivariable logistic regression analysis showed that sevoflurane-based anesthesia was associated with an increased risk of POD compared with propofol-based anesthesia (odds ratio [OR], 4.120; 95% confidence interval [CI], 1.549−10.954; P = .005), whereas anesthetics were not associated with postoperative 30-day complications and the length of postoperative hospital stay. Older age (OR, 1.242 CI, 1.130−1.366; P < .001) and higher mean pain score at postoperative day 1 (OR, 1.338 CI, 1.056−1.696; P = .016) were also associated with an increased risk of POD. Conclusions Propofol-based anesthesia was associated with a lower incidence of POD than sevoflurane-based anesthesia in elderly patients after spine surgery.

Pro-Con Debate: Should All General Anesthesia Be Done Using Target-Controlled Propofol Infusion Guided by Objective Monitoring of Depth of Anesthesia?

“…Due to the pharmacokinetic properties of propofol the recovery times, particularly after short procedures, were good and it could be used as a replacement of VA. Furthermore, studies show less risk to develop postoperative delirium when anesthesia is done using propofol than with VA. [1][2][3] This is an advantage in an aver aging patient population and in a costly hospital environment where any additional hour or day of hospitalization needs to be avoided. In Chang et al's 3 study recent study from 2022, the risk of postoperative delirium in elderly patients undergoing spine surgery was increased 3-fold with sevoflurane anesthesia than with propofol anesthesia.…”

Total intravenous anesthesia for liver resections: anesthetic implications and safety

“…In a multicenter randomized controlled trial designed to study the incidence of postoperative delirium in two groups of patients assigned to light or deep anesthesia guided by bispectral index (BIS) monitoring, targeting light anesthesia was found to reduce the risk of POCD at 1 year (9% vs. 20% reduction based on an Abbreviated Mental Test score ≤ 6, P < 0.001) [16]. To date, however, studies have been equivocal, resulting in a lack of convincing evidence of any difference in the incidence of POCD between propo-fol-TIVA and inhalational anesthesia [17][18][19][20][21]. Nevertheless, current guidelines Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia recommend the use of processed electroencephalogram (pEEG) monitoring when a neuromuscular blocking drug is used with TIVA [22], which may be beneficial for avoiding excessive anesthetic depth.…”

Propofol improves sleep deprivation‐induced sleep structural and cognitive deficits via upregulating the BMAL1 expression and suppressing microglial M1 polarization

“…Our previous studies confirmed this view: propofol (20 mg•kg −1 •h −1 , 6 h) inhibited oxidative stress by regulating the expression of bivalent metal transporter 1. 22 Although propofol has been reported to lessen the incidence of delirium and postoperative cognitive dysfunction, 23,24 its effect on SD-induced cognitive deficits has not been elucidated. Therefore, the present study aimed to investigate the role of propofol in inhibiting microglia hyperactivation, reducing inflammatory levels, and thereby facilitating sleep disorders and cognitive impairment caused by acute SD.…”