Farrer Thomas J, Monk Terri G, McDonagh David L, Martin Gavin, Pieper Carl F, Koltai Deborah
WWAMI Medical Eduction Program, University of Idaho, Moscow, ID, United States.
Department of Anesthesiology and Critical Care, SSM Saint Louis University Hospital St Louis, MO, United States.
Appl Neuropsychol Adult. 2025 Jul-Aug;32(4):1155-1161. doi: 10.1080/23279095.2023.2246612. Epub 2023 Aug 12.
The present prospective randomized study was designed to investigate whether the development of Post Operative Cognitive Decline (POCD) is related to anesthesia type in older adults. All patients were screened for delirium and mental status, received baseline neuropsychological assessment, and evaluation of activities of daily living (ADLs). Follow-up assessments were performed at 3-6 months and 12-18 months. Patients were randomized to receive either inhalation anesthesia (ISO) with isoflurane or total intravenous anesthesia (TIVA) with propofol for maintenance anesthesia. ISO (n = 99) and TIVA (n = 100) groups were similar in demographics, preoperative cognition, and incidence of post-operative delirium. Groups did not differ in terms of mean change in memory or executive function from baseline to follow-up. Pre-surgical cognitive function is the only variable predictive of the development of POCD. Anesthetic type was not predictive of POCD. However, ADLs were predictive of post-operative delirium development. Overall, this pilot study represents a prospective, randomized study demonstrating that when examining ISO versus TIVA for maintenance of general anesthesia, there is no significant difference in cognition between anesthetic types. There is also no difference in the occurrence of postoperative delirium. Postoperative cognitive decline was best predicted by lower baseline cognition and functional status.
本前瞻性随机研究旨在调查老年人术后认知功能减退（POCD）的发生是否与麻醉类型有关。所有患者均接受谵妄和精神状态筛查、基线神经心理学评估以及日常生活活动（ADL）评估。在3 - 6个月和12 - 18个月进行随访评估。患者被随机分为接受异氟烷吸入麻醉（ISO）或丙泊酚全静脉麻醉（TIVA）进行维持麻醉。ISO组（n = 99）和TIVA组（n = 100）在人口统计学、术前认知和术后谵妄发生率方面相似。从基线到随访，两组在记忆或执行功能的平均变化方面没有差异。术前认知功能是预测POCD发生的唯一变量。麻醉类型不能预测POCD。然而，ADL可预测术后谵妄的发生。总体而言，这项初步研究是一项前瞻性随机研究，表明在比较ISO和TIVA用于全身麻醉维持时，麻醉类型之间在认知方面没有显著差异。术后谵妄的发生也没有差异。术后认知功能减退最好通过较低的基线认知和功能状态来预测。
