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

Abstract

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.

The effect of TEMPOL pretreatment on postoperative cognitive function, inflammatory response, and oxidative stress in aged rats under sevoflurane anesthesia

“…Sevoflurane is mostly used for intraoperative anesthesia, and although the surgical procedure ITSELF may impact neuroinflammation, sevoflurane can exacerbate this neural damage. Sevoflurane can induce and exacerbate neuroinflammation by stimulating the production of inflammatory factors such as IL‐1β and TNF‐α; it can also induce neuronal oxidative damage by activating calcium‐dependent proteases, leading to the generation of a large number of oxygen free radicals, which promotes neuronal apoptosis and results in cognitive dysfunction 14–16 . TEMPOL is a novel free radical scavenger with the advantages of high stability and low molecular weight and has been widely used in research regarding ischemia‐reperfusion in the kidney, liver, and spinal cord 17 .…”

“…Sevoflurane can induce and exacerbate neuroinflammation by stimulating the production of inflammatory factors such as IL‐1β and TNF‐α; it can also induce neuronal oxidative damage by activating calcium‐dependent proteases, leading to the generation of a large number of oxygen free radicals, which promotes neuronal apoptosis and results in cognitive dysfunction. 14 , 15 , 16 TEMPOL is a novel free radical scavenger with the advantages of high stability and low molecular weight and has been widely used in research regarding ischemia‐reperfusion in the kidney, liver, and spinal cord. 17 Qi et al 18 found via in vitro experiments of Takotsubo syndrome that TEMPOL could improve oxidative dysfunction of mitochondria through the reactive oxygen/mitochondrial/antiapoptotic/p38 MAPK pathways.…”

The impact of inhalation anesthetics on early postoperative cognitive function and recovery characteristics in Down syndrome patients: a randomized, double – blind study

“…Various studies have investigated the impact of anesthetic agents on recovery and postoperative cognition, but it is difficult to compare our findings to theirs, since most of them were performed in elderly patient populations and have different methodologies, mainly using the Mini-Mental State Examination (MMSE) [5][6][7][8][9][10][11][12][13][14]. Additionally, they mostly focus on postoperative delirium in older age groups and postoperative cognitive dysfunction (POCD) that appears after patient discharge.…”

“…Among these studies, those which focused on recovery characteristics, suggest that desflurane is superior [6,8,13] or comparable to sevoflurane [10,11]. Similarly, studies focused on cognitive function, find desflurane slightly superior [7,8,12] or equivalent to sevoflurane [5,9,10,14]. To our knowledge there are no studies investigating early recovery and cognitive characteristics in younger patients with DS or any intellectual disability.…”

“…There are several studies comparing the two volatiles regarding their recovery characteristics and effects on postoperative cognition. Still, they are mainly focused on elderly population and present contradictory results, favoring none of the two or slightly favoring desflurane [5][6][7][8][9][10][11][12][13][14]. To our knowledge the present study is the first to examine the impact of the two most popular volatile anesthetics, namely desflurane and sevoflurane, on recovery and early postoperative cognitive function of patients with preexisting ID, specifically adult DS patients.…”