Konishi Y, Evered L A, Scott D A, Silbert B S
Fellow, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria; Teikyo University School of Medicine, Tokyo, Japan.
Associate Professor, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital; Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne; Melbourne, Victoria.
Anaesth Intensive Care. 2018 Nov;46(6):596-600. doi: 10.1177/0310057X1804600610.
It is unknown if the type of general anaesthetic used for maintenance of anaesthesia affects the incidence of postoperative cognitive dysfunction (POCD). The aim of this study was to compare the incidence of POCD in patients administered either sevoflurane or propofol for maintenance of anaesthesia during total hip replacement surgery. Following administration of a spinal anaesthetic, patients received either sevoflurane (n=121) or propofol (n=171) at the discretion of the anaesthetist for maintenance of general anaesthesia to maintain the processed electroencephalogram (bispectral index, BIS) under 60. POCD was assessed postoperatively at day 7, three months, and 12 months using a neurocognitive test battery. There was no statistically significant difference between the incidence of POCD at any timepoint with sevoflurane compared to propofol. The mean BIS was significantly lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [standard deviation, SD 7.5] in the sevoflurane group versus 53.7 [SD 8.1] in the propofol group, =0.0001). However, there was no statistically significant association between intraoperative BIS level and the incidence of POCD at any timepoint. Our results suggest that the incidence of POCD is not strongly influenced by the type of anaesthesia used in elderly patients.
用于维持麻醉的全身麻醉类型是否会影响术后认知功能障碍（POCD）的发生率尚不清楚。本研究的目的是比较在全髋关节置换手术中使用七氟醚或丙泊酚维持麻醉的患者中POCD的发生率。在给予脊髓麻醉后，由麻醉师酌情决定患者接受七氟醚（n = 121）或丙泊酚（n = 171）以维持全身麻醉，将处理后的脑电图（双谱指数，BIS）维持在60以下。在术后第7天、3个月和12个月使用神经认知测试组合评估POCD。与丙泊酚相比，七氟醚在任何时间点的POCD发生率均无统计学显著差异。七氟醚组的平均BIS显著低于丙泊酚组（七氟醚组平均BIS为44.3 [标准差，SD 7.5]，丙泊酚组为53.7 [SD 8.1]，P = 0.0001）。然而，在任何时间点，术中BIS水平与POCD发生率之间均无统计学显著关联。我们的结果表明，POCD的发生率不受老年患者所用麻醉类型的强烈影响。
