Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial
Abstract Study objective To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (> 60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Design Prospect...
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| Veröffentlicht in: | Journal of clinical anesthesia 2017-05, Vol.38, p.165-171 |
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| creator | Geng, Ying-jie Wu, Qing-hua Zhang, Rui-qin |
| description | Abstract Study objective To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (> 60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Design Prospective, randomized, double-blind clinical trial. Setting University-affiliated teaching hospital. Patients One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Interventions Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1 h (T2) and 24 h (T3) postoperatively. Main results The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P < 0.001; propofol vs. sevoflurane: D1, P = 0.012; D3, P = 0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 ( P = 0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Conclusions Propofol anesthesia may be an option for elderly surgical patients. |
| doi_str_mv | 10.1016/j.jclinane.2017.02.007 |
| format | Article |
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Design Prospective, randomized, double-blind clinical trial. Setting University-affiliated teaching hospital. Patients One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Interventions Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1 h (T2) and 24 h (T3) postoperatively. Main results The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P < 0.001; propofol vs. sevoflurane: D1, P = 0.012; D3, P = 0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 ( P = 0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Conclusions Propofol anesthesia may be an option for elderly surgical patients.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2017.02.007</identifier><identifier>PMID: 28372661</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Aged ; Airway management ; Anesthesia ; Anesthesia & Perioperative Care ; Anesthesia - adverse effects ; Anesthesia - methods ; Anesthesiology ; Anesthetics, Inhalation - administration & dosage ; Anesthetics, Inhalation - adverse effects ; Anesthetics, Intravenous - administration & dosage ; Anesthetics, Intravenous - adverse effects ; Apoptosis ; Biomarkers - blood ; Blood-brain barrier ; Cholecystectomy ; Cholecystectomy, Laparoscopic - adverse effects ; Clinical trials ; Cognitive ability ; Cognitive Dysfunction - blood ; Cognitive Dysfunction - chemically induced ; Cognitive Dysfunction - epidemiology ; Double-Blind Method ; Elderly ; Electrocardiography ; Female ; Heart rate ; Humans ; Incidence ; Intubation ; Isoflurane - administration & dosage ; Isoflurane - adverse effects ; Laparoscopy ; Male ; Methyl Ethers - administration & dosage ; Methyl Ethers - adverse effects ; Mortality ; Neuropsychological Tests ; Pain Medicine ; Patients ; Pharmaceuticals ; Physiology ; Postoperative cognitive dysfunction ; Postoperative Complications - blood ; Postoperative Complications - chemically induced ; Postoperative Complications - epidemiology ; Propofol - administration & dosage ; Propofol - adverse effects ; Prospective Studies ; Proteins ; Risk Factors ; Rodents ; Time Factors ; Trauma]]></subject><ispartof>Journal of clinical anesthesia, 2017-05, Vol.38, p.165-171</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c517t-9eefebef7b437dae0ab52c916bdcc3936fb5ce37603a261fe6b2a579e3827d203</citedby><cites>FETCH-LOGICAL-c517t-9eefebef7b437dae0ab52c916bdcc3936fb5ce37603a261fe6b2a579e3827d203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0952818017301642$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28372661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Geng, Ying-jie</creatorcontrib><creatorcontrib>Wu, Qing-hua</creatorcontrib><creatorcontrib>Zhang, Rui-qin</creatorcontrib><title>Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Abstract Study objective To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (> 60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Design Prospective, randomized, double-blind clinical trial. Setting University-affiliated teaching hospital. Patients One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Interventions Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1 h (T2) and 24 h (T3) postoperatively. Main results The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P < 0.001; propofol vs. sevoflurane: D1, P = 0.012; D3, P = 0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 ( P = 0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Conclusions Propofol anesthesia may be an option for elderly surgical patients.</description><subject>Aged</subject><subject>Airway management</subject><subject>Anesthesia</subject><subject>Anesthesia & Perioperative Care</subject><subject>Anesthesia - adverse effects</subject><subject>Anesthesia - methods</subject><subject>Anesthesiology</subject><subject>Anesthetics, Inhalation - administration & dosage</subject><subject>Anesthetics, Inhalation - adverse effects</subject><subject>Anesthetics, Intravenous - administration & dosage</subject><subject>Anesthetics, Intravenous - adverse effects</subject><subject>Apoptosis</subject><subject>Biomarkers - blood</subject><subject>Blood-brain barrier</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy, Laparoscopic - adverse effects</subject><subject>Clinical trials</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction - blood</subject><subject>Cognitive Dysfunction - chemically induced</subject><subject>Cognitive Dysfunction - epidemiology</subject><subject>Double-Blind Method</subject><subject>Elderly</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intubation</subject><subject>Isoflurane - administration & dosage</subject><subject>Isoflurane - adverse effects</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Methyl Ethers - administration & dosage</subject><subject>Methyl Ethers - adverse effects</subject><subject>Mortality</subject><subject>Neuropsychological Tests</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pharmaceuticals</subject><subject>Physiology</subject><subject>Postoperative cognitive dysfunction</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - chemically induced</subject><subject>Postoperative Complications - epidemiology</subject><subject>Propofol - administration & dosage</subject><subject>Propofol - adverse effects</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Risk Factors</subject><subject>Rodents</subject><subject>Time Factors</subject><subject>Trauma</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFks1u1DAUhSMEotPCK1SW2LDoDP5J4oQFoqpaQKrEAlhbjnNdPHjsYCeDwlPxiNwwHZC6YeVr-bvn2ue4KM4Z3TDK6lfbzdZ4F3SADadMbijfUCofFSvWSLEuK94-Lla0rfi6YQ09KU5z3lJK8YA9LU54IySva7Yqfl1bC2Yk0ZIhxSHa6C9Ihn20fkqofkF06InLxz2JgQwxj3GApEe3B2LiXXB_qn7OdgpmdMigjo8_XLgjXg86xWzi4AwxX6MHM-cRZ8bdTFwg4HtIfiYDykEY82tySXBSH3fuJ_QoH8aEYliOyWn_rHhitc_w_H49K77cXH--er--_fjuw9Xl7dpUTI7rFsBCB1Z2pZC9Bqq7ipuW1V1vjGhFbbvKgJA1FZrXzELdcV3JFkTDZc-pOCteHnTRlu8T5FHtXDbgPZoQp6xY05RM0pLXiL54gG7jlALebqEq2vK6KZGqD5RBN3ICq4bkdjrNilG1ZKq26pipWjJVlCvMFBvP7-Wnbgf937ZjiAi8PQCAfuwdJJUNWmmgdwl9Vn10_5_x5oHEQjmj_TeYIf97j8rYoD4tP2v5WEwKVC25-A2LCdDy</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Geng, Ying-jie</creator><creator>Wu, Qing-hua</creator><creator>Zhang, Rui-qin</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170501</creationdate><title>Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial</title><author>Geng, Ying-jie ; Wu, Qing-hua ; Zhang, Rui-qin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c517t-9eefebef7b437dae0ab52c916bdcc3936fb5ce37603a261fe6b2a579e3827d203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Airway management</topic><topic>Anesthesia</topic><topic>Anesthesia & Perioperative Care</topic><topic>Anesthesia - adverse effects</topic><topic>Anesthesia - methods</topic><topic>Anesthesiology</topic><topic>Anesthetics, Inhalation - administration & dosage</topic><topic>Anesthetics, Inhalation - adverse effects</topic><topic>Anesthetics, Intravenous - administration & dosage</topic><topic>Anesthetics, Intravenous - adverse effects</topic><topic>Apoptosis</topic><topic>Biomarkers - blood</topic><topic>Blood-brain barrier</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy, Laparoscopic - adverse effects</topic><topic>Clinical trials</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction - blood</topic><topic>Cognitive Dysfunction - chemically induced</topic><topic>Cognitive Dysfunction - epidemiology</topic><topic>Double-Blind Method</topic><topic>Elderly</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intubation</topic><topic>Isoflurane - administration & dosage</topic><topic>Isoflurane - adverse effects</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Methyl Ethers - administration & dosage</topic><topic>Methyl Ethers - adverse effects</topic><topic>Mortality</topic><topic>Neuropsychological Tests</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pharmaceuticals</topic><topic>Physiology</topic><topic>Postoperative cognitive dysfunction</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - chemically induced</topic><topic>Postoperative Complications - epidemiology</topic><topic>Propofol - administration & dosage</topic><topic>Propofol - adverse effects</topic><topic>Prospective Studies</topic><topic>Proteins</topic><topic>Risk Factors</topic><topic>Rodents</topic><topic>Time Factors</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Geng, Ying-jie</creatorcontrib><creatorcontrib>Wu, Qing-hua</creatorcontrib><creatorcontrib>Zhang, Rui-qin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Geng, Ying-jie</au><au>Wu, Qing-hua</au><au>Zhang, Rui-qin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>38</volume><spage>165</spage><epage>171</epage><pages>165-171</pages><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>Abstract Study objective To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (> 60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Design Prospective, randomized, double-blind clinical trial. Setting University-affiliated teaching hospital. Patients One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Interventions Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1 h (T2) and 24 h (T3) postoperatively. Main results The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P < 0.001; propofol vs. sevoflurane: D1, P = 0.012; D3, P = 0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 ( P = 0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Conclusions Propofol anesthesia may be an option for elderly surgical patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28372661</pmid><doi>10.1016/j.jclinane.2017.02.007</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of clinical anesthesia, 2017-05, Vol.38, p.165-171 |
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| subjects | Aged Airway management Anesthesia Anesthesia & Perioperative Care Anesthesia - adverse effects Anesthesia - methods Anesthesiology Anesthetics, Inhalation - administration & dosage Anesthetics, Inhalation - adverse effects Anesthetics, Intravenous - administration & dosage Anesthetics, Intravenous - adverse effects Apoptosis Biomarkers - blood Blood-brain barrier Cholecystectomy Cholecystectomy, Laparoscopic - adverse effects Clinical trials Cognitive ability Cognitive Dysfunction - blood Cognitive Dysfunction - chemically induced Cognitive Dysfunction - epidemiology Double-Blind Method Elderly Electrocardiography Female Heart rate Humans Incidence Intubation Isoflurane - administration & dosage Isoflurane - adverse effects Laparoscopy Male Methyl Ethers - administration & dosage Methyl Ethers - adverse effects Mortality Neuropsychological Tests Pain Medicine Patients Pharmaceuticals Physiology Postoperative cognitive dysfunction Postoperative Complications - blood Postoperative Complications - chemically induced Postoperative Complications - epidemiology Propofol - administration & dosage Propofol - adverse effects Prospective Studies Proteins Risk Factors Rodents Time Factors Trauma |
| title | Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial |
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