Comparison between remifentanil-sevoflurane and sufentanil-sevoflurane for general anesthesia on the early recovery of cognitive function in elderly patients

Abstract

Objective To explore the effects of remifentanil-sevoflurane and sufentanil-sevoflurane for general anesthesia on the early recovery of cognitive function in elderly patients postoperative period.Methods Sixty ASA physical Status Ⅰ-Ⅱ patients (aged 60 y-75 y) were randomly assigned to one of two study groups:anesthesia with remifentanil-sevoflurane (R group) and sufentanil-sevoflurane (S group).Induction of anesthesia was performed by administering sevoflurane constantly.Anaesthesia was induced either with remifentanil (1 μg/kg) or sufentanil (0.3 μg/kg) infusion,after loss of consciousness,rocuronium (0.9 mg/kg) was administered to facilitate endotracheal intubation.Remifentanil and sufentanil were subsequently titrated to lower doses according to the clinical need defined as the minimal dose required formaintaining MAP within 20％ of baseline.Sevoflurane was administered at the discretion of the anaesthesiologist to keep the bispectral index (BIS) between 40 and 50.To evaluate cognitive function the Short Orientation Memory Concentration Test(SOMCT) and Rancho Los Amigos Scale(RLAS) were administered to all patients in a double-blind procedure before surgery and at 1,3,6 h and 24 h after extubation (T0,T1,T2,T3,T4).Results There was no significant differences in SOMCT scores and RLAS GradeⅧ at baseline in the two groups.SOMCT scores were significantly reduced in both groups at T1 and recovered to the preoperative level at T2 in R group,but at T3 in S group (P＜0.05).RLAS GradeⅧ were significantly reduced in both groups,at T1 23 patients(77％) in R group and 8 patients (27％) in the S group (P＜0.05),whereas at T2 28 patients (93％) in R group and 15 patients (50％) in the S group(P＜0.05).At T3 and T4 after extubation the RLAS Grade was (aim)ilar in the two groups.Conclusions These preliminary data show remifentanil-sevoflurane and sufentanil-sevoflurane can induce similar intraoperative haemodynamics and extubation time,though the early cognitive recovery is faster after use of remifentanil-sevoflurane than that of sufentanil-sevoflurane. Key words: General anesthesia; Postoperative cognitive recovery; Sevoflurane; Remifentanil; Sufentanil