title: Cognitive function and oxidative stress after carotid endarterectomy: comparison of propofol to sevoflurane anesthesia.
abstract: OBJECTIVE
  To examine the antioxidant role of propofol in ischemia-reperfusion during carotid endarterectomy (CEA) and its influence on cognitive dysfunction after CEA.
  
  
  METHODS
  A randomized prospective study.
  
  
  METHODS
  Single-center study in a university hospital.
  
  
  METHODS
  Forty-four patients.
  
  
  METHODS
  Patients underwent elective CEA under general anesthesia with either sevoflurane (group S, n = 21) or propofol (group P, n = 23).
  
  
  RESULTS
  Cognitive function was assessed with the Mini-Mental State Examination (MMSE) before CEA, 1 hour after CEA, and 24 hours after CEA. Blood samples from the radial artery and the internal jugular vein were drawn before carotid clamping and 5 minutes following unclamping, and peripheral blood was obtained 24 hours postoperatively. Samples were analyzed for lactate, S100B, and P-selectin concentrations and for the antioxidative markers malondialdehyde/low-density lipoprotein ratio and nitrate + nitrite concentrations. Compared with group S, patients in group P exhibited a greater increase in their MMSE values 24 hours postoperatively. Patients who had their MMSE performance reduced at 24 hours also were significantly fewer in group P (13% v 43% in group S, p<0.05). Significantly lower levels of lactate and S100B were observed in arterial and jugular vein samples in group P. In addition, the jugular vein-arterial differences of malondialdehyde-to-low-density lipoprotein ratio and nitrates + nitrites concentrations were lower during propofol anesthesia.
  
  
  CONCLUSIONS
  Propofol seemed to improve cognitive performance after CEA. This improvement was associated with decreased indices of ischemic cerebral damage and seemed to be due to antioxidative effect in the ischemic cerebral circulation.
authors.affiliation: Second Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kalimeris
authors.forename: Stefania
authors.initials: S
authors.lastname: Kouni
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
authors.forename: Tzortzis
authors.initials: T
authors.lastname: Nomikos
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fragopoulou
authors.forename: John
authors.initials: J
authors.lastname: Kakisis
authors.forename: Spyridon
authors.initials: S
authors.lastname: Vasdekis
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Matsota
authors.forename: Ageliki
authors.initials: A
authors.lastname: Pandazi
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003071:Cognition / Q000502:physiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D015227:Lipid Peroxidation / Q000187:drug effects; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008738:Methyl Ethers; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009483:Neuropsychological Tests; D009566:Nitrates / Q000097:blood; D009573:Nitrites / Q000097:blood; D018384:Oxidative Stress / Q000502:physiology*; D019007:P-Selectin / Q000097:blood; D015742:Propofol; D009418:S100 Proteins / Q000097:blood; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008077:Lipoproteins, LDL; D008738:Methyl Ethers; D009566:Nitrates; D009573:Nitrites; D019007:P-Selectin; D009418:S100 Proteins; D019344:Lactic Acid; D000077149:Sevoflurane; D008315:Malondialdehyde; D015742:Propofol
keywords: carotid endarterectomy; cognitive dysfunction; oxidative stress; propofol