title: Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery.
abstract: OBJECTIVE
  Postoperative cognitive dysfunction is a frequent complication occurring in geriatric patients. Type of anesthesia and the patient's inflammatory response may contribute to postoperative cognitive dysfunction (POCD). In this prospective randomized double-blinded controlled study we hypothesized that intraoperative remifentanil may reduce immediate and early POCD compared to fentanyl and evaluated if there is a correlation between cognitive status and postoperative inflammatory cytokines level.
  
  
  METHODS
  Six hundred twenty-two patients older than 60 years undergoing major abdominal surgery were randomly assigned to two groups and treated with different opioids during surgery: continuous infusion of remifentanil or fentanyl boluses. Twenty-five patients per group were randomly selected for the quantitative determination of serum interleukin (IL)-1β, IL-6, and IL-10 to return to the ward and to the seventh postoperative day.
  
  
  RESULTS
  Cognitive status and its correlation with cytokines levels were assessed. The groups were comparable regarding to POCD incidence; however, IL-6 levels were lower the seventh day after surgery for remifentanil group (P= .04). No correlation was found between POCD and cytokine levels.
  
  
  CONCLUSIONS
  The use of remifentanil does not reduce POCD.
authors.affiliation: Department of Anesthesia and Intensive Care, Integrated Complex Columbus, Catholic University of Sacred Heart, Rome, Italy. Electronic address: gdecosmo@rm.unicatt.it.
authors.forename: Germano
authors.initials: G
authors.lastname: De Cosmo
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Flaminio
authors.initials: F
authors.lastname: Sessa
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Fiorini
authors.affiliation: Department of Anesthesia and Intensive Care, Antonio Perrino Hospital, Brindisi, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Congedo
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000698:Analgesia / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D016753:Interleukin-10 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced*; D011184:Postoperative Period; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; C508609:IL10 protein, human; C508585:IL1B protein, human; C508600:IL6 protein, human; D053583:Interleukin-1beta; D015850:Interleukin-6; D010880:Piperidines; D016753:Interleukin-10; D000077208:Remifentanil; D005283:Fentanyl
keywords: Analgesia; Cytokines; Fentanyl; Post operative cognitive dysfunction; Remifentanil