In patients having laparoscopic abdominal surgery, there was no difference in incidence of delayed neurocognitive recovery between propofol and sevoflurane-based anaesthesia.

pearl

• Yujuan Li, Dongtai Chen, Hanbing Wang, Zhi Wang, Furong Song, Hui Li, Li Ling, Zhiwen Shen, Chuwen Hu, Jun Peng, Weixing Li, Wei Xing, Jiahao Pan, Hua Liang, Qiaoling Zhou, Jun Cai, Ziqing He, Shuling Peng, Weian Zeng, and Zhiyi Zuo.
• Anesthesiology. 2021 Mar 1; 134 (3): 381-394.

BackgroundDelayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur.MethodsA randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery.ResultsA total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups.ConclusionsAnesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery.Editor’s PerspectiveCopyright © 2021, the American Society of Anesthesiologists, Inc. All Rights Reserved.

31 keywords...

hide…