Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial

Study objective: To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60 years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Design: Prospective, randomized, double-blind clinical trial. Setting: University-affiliated teaching hospital. Patients: One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Interventions: Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1 day before surgery [DO]), and on postoperative day 1 (01) and day 3 (D3). Plasma S-100 beta and A beta(1-40) protein, IL-1 beta, IL-6 and TNF-alpha concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1 h (T2) and 24 h (T3) postoperatively. Main results: The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P < 0.001; propofol vs. sevoflurane: D1, P = 0.012; D3, P = 0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P = 0.041), but not at D3. Postoperatively, plasma S-100 beta and A beta(1-40) protein, IL-1 beta, IL-6, and TNF-alpha concentrations were significantly decreased in the propofol group compared to the isoflurane group. Conclusions: Propofol anesthesia may be an option for elderly surgical patients. (C) 2017 Elsevier Inc. All rights reserved.