Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly.
OBJECTIVE
Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ss protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery.


METHODS
Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100beta protein and Neuron-Specific Enolase levels were also documented.


RESULTS
POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100beta protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values.


CONCLUSIONS
The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100beta protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.
Rohan
Denise
D
Department of Anesthesia, Critical Care and Pain Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland.
Buggy
Donal J
DJ
Crowley
Seamus
S
Ling
Ferraby K H
FK
Gallagher
Helen
H
Regan
Ciaran
C
Moriarty
Denis C
DC
D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D003072:Cognition Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D009483:Neuropsychological Tests; D010751:Phosphopyruvate Hydratase / Q000097:blood; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology*; D015742:Propofol; D009418:S100 Proteins / Q000097:blood; D000077149:Sevoflurane; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D008738:Methyl Ethers; D009418:S100 Proteins; D000077149:Sevoflurane; D010751:Phosphopyruvate Hydratase; D015742:Propofol