Comparison of effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number tablepropofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P ＜ 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.