Abstract
Purpose
Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ß protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery.
Methods
Patients (n = 30, mean age 73, range 65–86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100ß protein and Neuron-Specific Enolase levels were also documented.
Results
POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100ß protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values.
Conclusion
The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100ß protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.
Résumé
Objectif
Le dysfonctionnement cognitif postopératoire (DCPO) se manifeste chez 26% des patients âgés, sept jours après une opération non cardiaque majeure. Nous avons évalué l’incidence de DCPO et les modifications des marqueurs sériques d’atteinte neuronale (protéine S- 100ß et énolase neurospécifique), 24 h après une anesthésie à un seul médicament, le propofol ou le sévoflurane, chez des patients âgés qui ont subi une opération mineure.
Méthode
Les patients (n = 30, moyenne de 73 ans, limites de 65–86 ans) opérés pour cystoscopie ou hystéroscopie, ont été randomisés à l’insu d’un observateur pour une anesthésie avec propofol ou sévoflurane. Les changements aux tests neuropsychologiques (test Stroop, test modifié de remémoration de mots) ont été notés 24 h après l’opération et comparés à ceux de sujets témoins appariés selon l’âge (n = 15) au moyen de l’analyse de l’écart réduit. On a aussi noté les changements de niveaux de protéines S- 100ß et d’énolase neurospécifique.
Résultats
Le DCPO était présent chez 7/15 [47% (intervalle de confiance de 95% (IC) 21 à 72%)] patients qui ont reçu le propofol et chez 7/15 [47%(ICde95% 21 à 72%)] patients qui ont reçu le sévoflurane, comparativement à 1/15 [7% (IC de 95% 6 a 19%)] témoins, P = 0,03. Les niveaux de protéines S- 100ß et d’énolase neurospécifique n’étaient pas significativement différents avant et après l’opération sous anesthésie.
Conclusion
Le premier jour après une opération mineure, l’incidence de DCPO chez les patients âgés est plus élevée qu’on ne le rapportait auparavant sept jours après une intervention majeure. Elle est augmentée avec le propofol et le sévoflurane, en comparaison avec des témoins du même âge. Les niveaux de protéines S- 100ß et d’énolase neurospécifique ne sont pas modifiés par la technique anesthésique.
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Rohan, D., Buggy, D.J., Crowley, S. et al. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly. Can J Anaesth 52, 137–142 (2005). https://doi.org/10.1007/BF03027718
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DOI: https://doi.org/10.1007/BF03027718