Effect of Midazolam on Immediate Cognitive Function during Total Intravenous Anesthesia in Elderly Hepatocellular Carcinoma Patients Undergoing Radiofrequency Ablation

Abstract

Background: Previous studies showed that midazolam had some effects on cognitive dysfunction. Objective: To study the drug effects by using the Montreal Cognitive Assessment Test to assess cognitive function in the elderly with hepatocellular carcinoma during total intravenous anesthesia (TIVA) after radiofrequency ablation (RFA). Materials and Methods: Ninety geriatric patients, aged 65 to 80 scheduling for RFA under TIVA were randomized into two groups, A (n=51) receiving midazolam and B (n=39) without midazolam. Prior to the procedure, the first Montreal Cognitive Assessment Test was done. The second test was done when the patients gained full-conscious in the recovery room. Results: The pre-test and post-test scores were comparable between the two groups. Interestingly, the participants in group A and B had normal scores prior to starting the anesthesia and the score decreased after the surgical procedure. Fifty-one and thirty-four patients, with and without midazolam showed the incidence of cognitive dysfunction as 33.3% and 14.7%, respectively. The score in group A appeared to decrease significantly (p<0.01) after the operation. This was not observed in group B. Conclusion: Under TIVA with midazolam, 60% of the elderly with hepatocellular carcinoma after RFA showed a significant decrease of immediate cognitive function. Keywords: Elderly, Midazolam, Montreal Cognitive Assessment Test, Radiofrequency ablation.