This study was aimed to systematically evaluate the effects of fentanyl and sufentanil on intraoperative cerebral oxygen saturation changes and postoperative cognitive function in elderly patients undergoing open surgery. Ninety-six elderly patients who had undergone open surgery under general anesthesia were randomly divided into fentanyl group (F group, anesthesia by fentanyl, 4 g/kg) and sufentanil group (S group, anesthesia by sufentanil, 0.4 µg/kg). There were no significant differences between the F group and S group in the general characteristics of patients. Compared to the F group, the S group had a better effect on suppressing the stress response, maintaining a stable hemodynamic status and achieving better anesthesia effects. The anesthesia recovery time of the S group was significantly shorter than that of the F group. There was no significant difference between the two groups in the intraoperative and postoperative agitation. Patient’s waking time and extubation time were significantly shorter in the S group than the F group. The VAS scores in the S group were significantly lower than those in the F group at each time point. The Ramsay scores in the S group were significantly higher than those in the F group at each time point. The cerebral oxygen saturation (SctO2) levels in both groups were significantly increased following anesthesia induction and intubation compared to that of the awake state (P < 0.05), and SctO2 was significantly decreased during the surgery in both groups. The changes in SctO2 levels were not significantly different between the two groups (P > 0.05). The SctO2 level was significantly higher during surgery than that after intubation. Compared with the F group, the relative value of SctO2 decline in the S group was smaller. Compared to the day before surgery, the Montreal Cognitive Assessment (MoCA) scores of both groups were significantly reduced after surgery. At 1 day post-surgery, the MoCA scores of the S group were significantly higher and the incidence of postoperative cognitive dysfunction (POCD) was significantly lower compared to the F group. POCD occurred in three patients (6.2%) in the S group, and the ratio was significantly lower than that in the F group (11.9%) (P < 0.05). It showed a consistent trend with the SctO2 status during the surgery. The relative value of SctO2 decline in the S group was significantly smaller than that in the F group. The reduction of cognitive function in the S group was significantly lower than that in the F group. These results indicate that the changes in SctO2 are a good prediction of the incidence of POCD.
Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 351:857–861CrossRefGoogle Scholar
Clotz MA, Nahata MC (1991) Clinical uses of fentanyl, sufentanil, and alfentanil. Clin Pharm 10:581–593Google Scholar
Pouraghaei M, Moharamzadeh P, Soleimanpour H et al (2014) Comparison between the effects of alfentanil, fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department. Anesth Pain Med 4:e14618. https://doi.org/10.5812/aapm.14618Google Scholar
Farzi F, Mirmansouri A, Naderi Nabi B et al (2017) Comparing the effect of adding fentanyl, sufentanil, and placebo with intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing cesarean section. Anesth Pain Med 7:e12738. https://doi.org/10.5812/aapm.12738Google Scholar
Martorano PP, Aloj F, Baietta S et al (2008) Sufentanil-propofol vs remifentanil-propofol during total intravenous anesthesia for neurosurgery. A multicentre study. Minerva Anestesiol 74:233–243Google Scholar
Kofke WA, Garman RH, Janosky J et al (1996) Opioid neurotoxicity: neuropathologic effects in rats of different fentanyl congeners and the effects of hexamethonium-induced normotension. Anesth Analg 83:141–146CrossRefGoogle Scholar
Silbert BS, Scott DA, Evered LA et al (2006) A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly. Anesthesiology 104:1137–1145CrossRefGoogle Scholar