ObjectiveDelirium and postoperative cognitive dysfunction (POCD) are major causes of morbidity after coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB). Anesthetic agents such as propofol and sevoflurane potentially have a role in pathogenesis of cognitive dysfunction. There is scarce literature comparing these two agents in CABG with CPB despite the relatively high incidence of cognitive dysfunction in this patient population. The authors compared the incidence of delirium and early POCD (at one week) between propofol-based TIVA and volatile anesthesia with sevoflurane in adult patients undergoing elective CABG with CPB. DesignA prospective randomized single blinded study. SettingThis study was conducted at a single institution (Sree Chitra Tirunal Institute for Medical Sciences and Technology, a Tertiary care Institute and a university level teaching hospital) ParticipantsSeventy two patients undergoing elective CABG under CPB participated in this study. InterventionsThis study was conducted on 72 adult patients (> 18 years) undergoing elective CABG under CPB who were randomised to receive propofol or sevoflurane. Anesthetic depth was monitored to maintain bispectral index between 40-60. Delirium was assessed using the Confusion-Assessment Method for the intensive care unit (CAM-ICU). Early POCD was diagnosed when there was a reduction of > 2 points in the Montreal Cognitive Assessment (MoCA) score compared to baseline. Cerebral oximetry changes using near infrared spectroscopy (NIRS), atheroma grades and intraoperative variables were compared between the two groups. Measurements & Main ResultsSeventy-two patients were randomised to receive propofol (36) or sevoflurane (36). The mean age was 59.4 years (SD 8.6 years). The baseline and intraoperative variables including atheroma grades, NIRS values, hemoglobin, glycemic control, oxygenation were comparable between the two groups. Fifteen (21.7%) patients developed delirium and 31 (44.9%) had early POCD. The incidence of delirium was higher with sevoflurane (12, 34.2%) compared to propofol (3, 8.8%), OR 1.72 (95% CI: 1.13-2.62), p 0.027*. POCD was higher with sevoflurane (20, 57.1%) compared to propofol (11,32.3%), OR 1.63 (95% CI: 1.01-2.62), p value 0.038*. In patients age > 65 years, delirium was higher with sevoflurane (7/11,63.6%) compared to propofol (1/7, 14.2%), p 0.03*. ConclusionsPropofol based TIVA was associated with a lower incidence of delirium and POCD compared to sevoflurane in this cohort of patients undergoing CABG under CPB. Large scale, multi-centre, randomized trials with longer follow-up duration are needed to substantiate the clinical relevance of this observation.