A comparison of desflurane and sevoflurane in the recovery of cognitive function after general anesthesia in elderly patients
Keywords:Desflurane, Sevoflurane, Cognition, MMSE, Geriatric patients, POCD
Background: The postoperative cognitive dysfunction (POCD) or psychomotor function disorder is known to be associated with the anesthetic agents, as well as the physiological changes resulting from the anesthesia. The known risk factors are old age, preexisting cerebral cardiac or vascular disease, alcohol abuse, intra and post-operative complications.
Methods: 50 patients above 65 years of age falling into ASA Grade 1, 2, or 3 were catagrzed into 2 groups, one (Group A) wherein sevoflurane was given as the anesthetic agent and the other (Group B) where desflurane was administered. All had undergone physical and regular blood examination. MMSE score was taken for all patients for cognitive recognition before surgery and 1, 3, and 6 hours after surgery.
Results: Of the 50 patients, the MMSE score was above 27 for all before surgery, while, post-surgery it was below 27 after I hour in 100% of the cases. After 3 hours, in Group A, the mean MMSE was above 27 while it was still below 27 in Group B while it was above 27 in both the Groups after 6 hours post-surgery. There was only 1 cases of POCD after 6 hours in Group A and none in Group B. The recovery time was faster in Group B as compared to Group A.
Conclusions: Desflurane was marginally a better anesthetic agent in terms or recovery to sevoflurane and sevoflurane was slightly better than the former when it came to cognitive recognition Therefore, we conclude that both the drugs are equally good anesthetic agents.
Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care. 2011;17:376-81.
Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857-61.
Öğün CÖ, Topal A, Duman A, Erol A, Ökesli S. Remifentanil-sevofluran-azotprotoksit anestezisinde propofol ve tiyopenton’un orta ve ileri Yaştaki Kadınlarda derlenmeye ve Erken Kognitif Fonksiyonlara Etkisi. J Turk Anaesth Int Care. 2002;30:209-17.
Hoke JF, Cunningham F, James MK, Muir KT, Hoffman WE. Comparative pharmacokinetics and pharmacodynamics of remifentanil, its principle metabolite (GR 90291) and alfentanil in dogs. J Pharmacol Exp Ther. 1997;281(1):226-32.
Ucuzal M, Akyolcu N. Postoperative cognitive changes in elderly. Turk J Geriatr. 2008;11(3):119-27.
Chen PL, Yang CW, Tseng YK, Sun WZ, Wang JL, Wang SJ, et al. Risk of dementia after anaesthesia and surgery. Br J Psychiatry. 2014;204:188-93.
Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X, et al. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Med Sci Monit. 2014;20:1908-12.
Davison LA, Steinhelber JC, Eger EI 2nd, Stevens WC. Psychological effects of halothane and isoflurane anesthesia. Anesthesiology. 1975;43:313-24.
Drummond GB. The assessment of postoperative mental function. Br J Anaesth. 1975;47:130-42.
Sebel PS, Hoke JF, Westmoreland C, Hug CC Jr, Muir KT, Szlam F. Histamine concentrations and hemodynamic responses after remifentanil. Anaest Analg. 1995;80(5):990-3.
Jindal R, Kumra VP, Narani KK, Sood J. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian J Anaesth. 2011;55:36-42.
Eberts TJ, Schmid PG. Inhaled anesthetics. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, eds. Clinical Anesthesia. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2009: 413-443.
Morgan GE Jr, Mikhail MS, Murray MJ. Inhalational anesthetics. In: Morgan GE Jr, Mikhail MS, Murray MJ, eds. Clinical Anesthesiology. 4th ed. New York: McGraw-Hill; 2006: 155-178.
Rasmussen L, Stygall J, Stanton PN. Cognitive dysfunction and other long-term complications of surgery and anesthesia. In: Rasmussen L, Stygall J, Stanton PN, eds. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010: 2805-2819.
Savita Babbar, Upasana Goswami, Saurabh Tiwari. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: a randomised prospective study. Indian J Anaesth. 2015 Mar;59(3):150-5.
Heavner JE, Kaye AD, Lin BK, King T. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anaesth. 2003;91(4):502-6.
Yasuda N, Targ AG, Eger EI 2nd. Solubility of the I-653, sevoflurane, isoflurane, and halothane in human tissues. Anesth Analg. 1989;69:370-3.
Gang Chen, Youfa Zhou, Qingyu Shi, Haiyan Zhou. Comparison of early recovery and cognitive function after desflurane and sevoflurane anaesthesia in elderly patients: a meta-analysis of randomized controlled trials. J Int Med Res. 2015 Oct;43(5):619-28.
Chen X, Zhao M, White PF, Li S, Tang J, Wender RH, et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg. 2001;93:1489-94.