Postoperative Neurocognitive Dysfunction in Elderly Patients after Xenon versus Propofol Anesthesia for Major Noncardiac Surgery

Abstract

Postoperative cognitive dysfunction (POCD) in elderly patients after noncardiac surgery is a common problem. The noble gas xenon has been demonstrated to exert substantial neuroprotective properties in animal studies. Therefore, this study was designed to assess POCD after xenon anesthesia in comparison to propofol in elderly patients undergoing major noncardiac surgery. After approval of the local ethical committee was obtained, 101 patients (American Society of Anesthesiologists physical status I-III; age, 65-83 yr) undergoing elective abdominal or urologic surgery (duration, > 2 h) were enrolled into this randomized, double-blinded controlled pilot study. Patients received anesthesia with sufentanil and either propofol or xenon and were assessed before treatment and 1, 6, and 30 days after treatment using a neuropsychological test battery based on previous studies investigating POCD. There were no significant differences in terms of age, American Society of Anesthesiologists status, education, duration of surgery, administered analgetics, and preoperative neurocognitive status between study groups. POCD as classified was present in 22 patients (44%) of the xenon group versus 25 patients (50%) of the propofol group 1 day after treatment, in 6 xenon patients (12%) versus 9 propofol patients (18%) 6 days after treatment, and in 3 xenon patients (6%) versus 6 propofol patients (12%) 30 days after treatment. These differences were not statistically significant. Postoperative impairment of neurocognitive function was observed in a substantial proportion of elderly patients even 30 days after treatment. Xenon-based anesthesia was not associated with decreased incidence of POCD in comparison to propofol.