Skip to main content

Comparative effects of fentanyl versus sufentanil on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing open surgery

Aging Clinical and Experimental Research volume 31, pages 1791–1800 (2019)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Sun W, Aodeng S, Tanimoto Y et al (2015) Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China. Arch Gerontol Geriatr 60:311–316. https://doi.org/10.1016/j.archger.2014.12.002

    Article  PubMed  Google Scholar 

  2. De Luca d’Alessandro E, Bonacci S, Giraldi G (2011) Aging populations: the health and quality of life of the elderly. Clin Ter 162:e13–e18

    PubMed  Google Scholar 

  3. Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928. https://doi.org/10.1016/S0140-6736(03)14966-5

    Article  PubMed  Google Scholar 

  4. Steinmetz J, Christensen KB, Lund T et al (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110:548–555. https://doi.org/10.1097/ALN.0b013e318195b569

    Article  PubMed  Google Scholar 

  5. 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 351:857–861

    Article  CAS  Google Scholar 

  6. Tang L, Kazan R, Taddei R et al (2012) Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth 108:623–629. https://doi.org/10.1093/bja/aer501

    Article  PubMed  CAS  Google Scholar 

  7. Chan MJ, Chung T, Glassford NJ et al (2017) Near-infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 31:1155–1165. https://doi.org/10.1053/j.jvca.2017.02.187

    Article  PubMed  Google Scholar 

  8. Lin R, Zhang F, Xue Q et al (2013) Accuracy of regional cerebral oxygen saturation in predicting postoperative cognitive dysfunction after total hip arthroplasty: regional cerebral oxygen saturation predicts POCD. J Arthroplasty 28:494–497. https://doi.org/10.1016/j.arth.2012.06.041

    Article  PubMed  Google Scholar 

  9. Clotz MA, Nahata MC (1991) Clinical uses of fentanyl, sufentanil, and alfentanil. Clin Pharm 10:581–593

    PubMed  CAS  Google Scholar 

  10. 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.14618

    Article  PubMed  PubMed Central  Google Scholar 

  11. Salazar F, Donate M, Boget T et al (2011) Intraoperative warming and post-operative cognitive dysfunction after total knee replacement. Acta Anaesthesiol Scand 55:216–222. https://doi.org/10.1111/j.1399-6576.2010.02362.x

    Article  PubMed  CAS  Google Scholar 

  12. Hemmerling TM, Bluteau MC, Kazan R et al (2008) Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth 101:870–875. https://doi.org/10.1093/bja/aen275

    Article  PubMed  CAS  Google Scholar 

  13. Dalrymple-Alford JC, MacAskill MR, Nakas CT et al (2010) The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 75:1717–1725. https://doi.org/10.1212/WNL.0b013e3181fc29c9

    Article  PubMed  CAS  Google Scholar 

  14. Nasreddine ZS, Phillips NA, Bedirian V et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

    Article  PubMed  Google Scholar 

  15. Newman SP (1995) Analysis and interpretation of neuropsychologic tests in cardiac surgery. Ann Thorac Surg 59:1351–1355

    Article  CAS  Google Scholar 

  16. Akan M, Oztekin S (2012) Endotracheal intubation without neuromuscular blocking agents: is it a good and safe option? Anesth Pain Med 1:267–268. https://doi.org/10.5812/aapm.3805

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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.12738

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ayrian E, Kaye AD, Varner CL et al (2015) Effects of anesthetic management on early postoperative recovery, hemodynamics and pain after supratentorial craniotomy. J Clin Med Res 7:731–741. https://doi.org/10.14740/jocmr2256w

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Leslie K, Troedel S, Irwin K et al (2003) Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology 99:1158–1165

    Article  Google Scholar 

  20. Royse CF, Newman S, Chung F et al (2010) Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale. Anesthesiology 113:892–905. https://doi.org/10.1097/ALN.0b013e3181d960a9

    Article  PubMed  Google Scholar 

  21. Modak SD, Kane DG (2017) Conscious sedation for balloon mitral valvotomy: a comparison of fentanyl versus sufentanil. Ann Card Anaesth 20:163–168. https://doi.org/10.4103/0971-9784.203930

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim J, Shim JK, Song JW et al (2016) Postoperative cognitive dysfunction and the change of regional cerebral oxygen saturation in elderly patients undergoing spinal surgery. Anesth Analg 123:436–444. https://doi.org/10.1213/ANE.0000000000001352

    Article  PubMed  Google Scholar 

  23. Ni C, Xu T, Li N et al (2015) Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction. BMC Anesthesiol 15:156. https://doi.org/10.1186/s12871-015-0117-6

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Brodt J, Vladinov G, Castillo-Pedraza C et al (2016) Changes in cerebral oxygen saturation during transcatheter aortic valve replacement. J Clin Monit Comput 30:649–653. https://doi.org/10.1007/s10877-015-9758-8

    Article  PubMed  Google Scholar 

  25. Terrando N, Brzezinski M, Degos V et al (2011) Perioperative cognitive decline in the aging population. Mayo Clin Proc 86:885–893. https://doi.org/10.4065/mcp.2011.0332

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shi HJ, Xue XH, Wang YL et al (2015) Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients. Int J Clin Exp Med 8:3883–3888

    PubMed  PubMed Central  Google Scholar 

  27. Egawa J, Inoue S, Nishiwada T et al (2016) Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial. Can J Anaesth 63:1161–1169. https://doi.org/10.1007/s12630-016-0700-4

    Article  PubMed  Google Scholar 

  28. De Cosmo G, Sessa F, Fiorini F et al (2016) Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery. J Clin Anesth 35:40–46. https://doi.org/10.1016/j.jclinane.2016.07.016

    Article  PubMed  CAS  Google Scholar 

  29. Rasmussen LA, Ryhammer PK, Greisen J et al (2016) Ultrashort acting remifentanil is not superior to long-acting sufentanil in preserving cognitive function—a randomized study. J Clin Anesth 33:127–134. https://doi.org/10.1016/j.jclinane.2016.03.023

    Article  PubMed  Google Scholar 

  30. Bilotta F, Caramia R, Paoloni FP et al (2007) Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol 24:122–127. https://doi.org/10.1017/S0265021506001244

    Article  PubMed  CAS  Google Scholar 

  31. 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 74:233–243

    PubMed  CAS  Google Scholar 

  32. 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 83:141–146

    Article  CAS  Google Scholar 

  33. 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 104:1137–1145

    Article  CAS  Google Scholar 

  34. Davis MP, Mehta Z (2016) Opioids and chronic pain: where is the balance? Curr Oncol Rep 18:71. https://doi.org/10.1007/s11912-016-0558-1

    Article  PubMed  CAS  Google Scholar 

  35. Brown RT, Zuelsdorff M, Fleming M (2006) Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain. J Opioid Manag 2:137–146

    Article  Google Scholar 

  36. Scott JC, Cooke JE, Stanski DR (1991) Electroencephalographic quantitation of opioid effect: comparative pharmacodynamics of fentanyl and sufentanil. Anesthesiology 74:34–42

    Article  CAS  Google Scholar 

  37. Rundshagen I (2014) Postoperative cognitive dysfunction. Dtsch Arztebl Int 111:119–125. https://doi.org/10.3238/arztebl.2014.0119

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No sources of funding were used to assist in the preparation of this article.

Author information

Affiliations

  1. Department of Anesthesia, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, No 246 Heping Road, Yaohai District, Hefei, 230011, Anhui, China

    Jun Zhang, Liang Chen, Yunyun Sun & Wensheng He

Authors
  1. Jun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yunyun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wensheng He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wensheng He.

Ethics declarations

Conflict of interest

Jun Zhang, Liang Chen, Yunyun Sun and Wensheng He have no conflict of interest to declare.

Statement of human and animal rights

All human studies were in accordance with Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects.

Informed consent

Informed consents were derived from all participants.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, J., Chen, L., Sun, Y. et al. Comparative effects of fentanyl versus sufentanil on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing open surgery. Aging Clin Exp Res 31, 1791–1800 (2019). https://doi.org/10.1007/s40520-019-01123-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01123-8

Keywords

  • Anesthesia
  • Fentanyl
  • Sufentanil
  • Cerebral oxygen saturation
  • Postoperative cognitive dysfunction