The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery*

Abstract

SummaryWe investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ‡ 1 SD deterioration in two or more of 12 neurocognitive tests. Secondary outcomes included early postoperative cognitive dysfunction (between days three and seven), delirium on day one, morbidity and length of hospital stay. Early postoperative cognitive dysfunction was significantly higher with propofol compared with desflurane (56 ⁄ 84 (67.5%) vs 41 ⁄ 83 (49.4%), respectively, p = 0.018), but this effect was not seen at 3 months (10 ⁄ 87 (11.2%) vs 9 ⁄ 90 (10.0%), respectively. There was no difference in delirium (7 ⁄ 89 (7.9%) vs 12 ⁄ 91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction. Postoperative cognitive dysfunction (POCD) is a common morbidity associated with coronary artery bypass surgery, ranging in frequency from 20% to 60% for between 6 weeks to 3 months after surgery [1][2][3]. It can be an enduring problem for patients, as the presence of POCD at 3 months after surgery has a high chance of persisting into the long term [3,4]. Much research has been devoted to investigating aspects of cardiopulmonary bypass that have been considered to be the most likely cause of POCD, with conflicting results. The focus on cardiopulmonary bypass, and consequent aortic manipulation required for aortic

Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery

“…44,45 Preliminary human data suggest that inhalational anesthetics may be associated with better short-term cognitive performance after on-pump CABG surgery. 46,47 In contrast, the incidence of delirium did not differ between the desflurane and propofol groups. 46 In the present trial, we also did not detect an influence of the volatile anesthetic sevoflurane on the incidence of delirium.…”

“…46,47 In contrast, the incidence of delirium did not differ between the desflurane and propofol groups. 46 In the present trial, we also did not detect an influence of the volatile anesthetic sevoflurane on the incidence of delirium.…”

Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial

“…9 We assumed that the incidence of POCD could be as high as 30% in the sevoflurane group and 10% in the propofol group. 22 Considering a 20% difference in incidence to be clinically significant, 144 patients would be needed to achieve a statistical power of 0.8 with a type I error of 0.05. To compensate for withdrawals, 148 patients were enrolled in the study.…”

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

“…In humans, deeper isoflurane anaesthesia titrated to the bispectral index (BIS) also results in better postoperative information processing [73]. Furthermore, two recent studies comparing propofol with sevoflurane [46] and desflurane [74] found a higher incidence of cognitive dysfunction in patients after propofol-based anaesthesia. These results suggest that there might even be a protective effect of inhalational anaesthesia, possibly mediated by so-called anaesthetic pre-and post-ischaemic conditioning.…”