title: Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial.
abstract: OBJECTIVE
  One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery.
  
  
  METHODS
  There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD.
  
  
  RESULTS
  Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD.
  
  
  CONCLUSIONS
  No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. (
  
  
  BACKGROUND
  UMIN 000002826).
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. junji-egawa@naramed-u.ac.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Egawa
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Satoki
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nishiwada
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tojo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawaguchi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Taniguchi
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Furuya
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawaguchi
mesh_terms: D000367:Age Factors; D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D001923:Brain Chemistry / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D061810:One-Lung Ventilation / Q000523:psychology; D010101:Oxygen Consumption / Q000187:drug effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology / Q000523:psychology*; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol