Comparison of effects of propofol- and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass

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 table: propofol-based anesthesia group(group P)and sevoflurane-based anesthesia group(group S). In group P, propofol 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. Key words: Propofol; Anesthetics, inhalation; Cardiopulmonary bypass; Heart valve prosthesis; Cognition disorders; Aged