Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial.

BACKGROUND AND OBJECTIVES: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.

Comparison of preoxygenation efficiency with Intersurgical Economy and Intersurgical QuadraLite anaesthetic face masks.

BACKGROUND: Sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. An optimally sealed facemask is necessary for fast preoxygenation. The study was aimed at comparing the efficiency of preoxygenation using two different face masks. MATERIALS AND METHODS: In 2018, a prospective study was conducted. Patients were classified into two groups: group A - Intersurgical Economy face masks, group B - Intersurgical QuadraLite masks. The circuit was flushed with 100% O2 for 30s, preoxygenation started with flow of 8l/min, FiO2100. The patients were asked to breathe deeply. Fentanyl (1-2 mcg/kg) was administered to increase mask toleration. End-tidal oxygen concentration (EtO2) ≥90% was the goal. EtO2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. Data was analyzed using the Independent-Samples T-test and the Mann-Whitney-U test. RESULTS: Twelve patients were enrolled in group A and 19 in group B. Differences in sex, age, BMI and Mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). Patients assigned to ASA I - 25.8% (n = 8->2/6), ASA II - 71.0 % (n = 22->10/12), ASA III - 3.2% (n = 1->0/1), p = 0.64. The success rate of preoxygenation to EtO290 within 5 min was statistically significantly different in the groups, with 33.3% in group A and 94.7% in group B (p < 0.01). Mean time to EtO290 was 228.3 ± 104.0/164.4 ± 84.3. Mean EtO2 after: 30s - 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s - 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s - 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s-69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s-71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s - 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s - 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s - 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s - 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). CONCLUSIONS: Preoxygenation was significantly more efficient and faster with Intersurgical QuadraLite face masks.

Effects of sevoflurane and desflurane on early cognitive changes after thyroid surgery: interim results.

The study is being conducted at the 1st Department of Anaesthesiology, the Centre of Abdominal Surgery, the Centre of Anaesthesiology, Intensive Care and Pain Management of Vilnius University Hospital Santaros Klinikos. BACKGROUND: These are primary results of a randomized double-blinded study comparing postoperative changes in cognitive functions and the effect of desflurane and sevoflurane on these changes. MATERIALS AND METHODS: The study includes patients of ≥40 years of age undergoing elective thyroid surgery under general anaesthesia. Patients were randomly allocated to either sevoflurane or desflurane group. Cognitive testing (memory, attention, and reasoning tasks) was performed a day before surgery and repeated 24 hours postoperatively. A decrease of 20% in the postoperative score was considered as postoperative cognitive dysfunction (POCD). RESULTS: At present 38 patients are included in the study. Median decrease in the postoperative score was 2.7% (IQR 16.7). The incidence of POCD was 2.6%. Significantly decreased memory scores were observed in 15.8% of patients. Both study groups were comparable based on demography, duration of anaesthesia, intraoperative opioids, postoperative pain, and satisfaction. No difference was found in the cognitive score comparing sevoflurane and desflurane groups, except for memory tasks where the sevoflurane group performed worse (p = 0.01).The age or the duration of anaesthesia did not affect postoperative scores. Postoperative satisfaction negatively correlated with the memory score (r = -0.35, p = 0.03). Postoperative satisfaction correlated with the reasoning score (r = -0.55; p < 0.01) and the total score (r = -0.42; p = 0.03) in the sevoflurane group. Likewise, temperature in the sevoflurane group correlated with the memory score (r = -0.58; p = 0.02). CONCLUSIONS: The desflurane group performs better in memory tasks, but no such advantage is found in the total cognitive score. In contrast to the age or anaesthesia duration, intraoperative temperature and postoperative satisfaction may affect postoperative cognitive performance.