title: The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery.
abstract: We investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ≥1 SD deterioration in two or more of 12 neurocognitive tests. Secondary outcomes included early postoperative cognitive dysfunction (between days three and seven), delirium on day one, morbidity and length of hospital stay. Early postoperative cognitive dysfunction was significantly higher with propofol compared with desflurane (56/84 (67.5%) vs 41/83 (49.4%), respectively, p=0.018), but this effect was not seen at 3 months (10/87 (11.2%) vs 9/90 (10.0%), respectively. There was no difference in delirium (7/89 (7.9%) vs 12/91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction.
authors.affiliation: Anaesthesia and Pain Management Unit, Department of Pharmacology, University of Melbourne, Carlton, Victoria. colin.royse@heartweb.com
authors.forename: C F
authors.initials: CF
authors.lastname: Royse
authors.forename: D T
authors.initials: DT
authors.lastname: Andrews
authors.forename: S N
authors.initials: SN
authors.lastname: Newman
authors.forename: J
authors.initials: J
authors.lastname: Stygall
authors.forename: Z
authors.initials: Z
authors.lastname: Williams
authors.forename: J
authors.initials: J
authors.lastname: Pang
authors.forename: A G
authors.initials: AG
authors.lastname: Royse
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D000077335:Desflurane; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015742:Propofol / Q000494:pharmacology*; D012307:Risk Factors
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol