The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients
Abstract
Background: The fast expanding demographic segment of the elderly population has resulted in an increase in the people aged 65 y and above, needing surgical treatments. This change has posed special medical problems including need of surgical management, while preventing postoperative complications. We compared the postoperative cognitive injury in older adults between total intravenous anesthesia (TIVA) and inhalational anesthesia. It lays the groundwork for anesthesiology and perioperative care research and clinical choices in elderly.
Methodology: With exclusions for cognitive disabilities and neurologic disorders, participants of ≥ 65 y of age, scheduled for elective surgery, were randomly assigned to TIVA or inhalational anesthesia groups. Preoperative exams were carried out, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) cognitive tests. While the inhalation group got inhalational sevoflurane or desflurane with opioids, TIVA group received propofol and remifentanil IV. The incidence of Postoperative Cognitive Dysfunction (POCD) was the main outcome; while secondary outcomes included hospital stay, any complications, anesthesia and surgery durations and three-month mortality.
Results: On days 1 and 3 postoperative cognitive scores (POCS) dropped dramatically; on day 7 in both TIVA and inhalational anesthesia groups, they rose again. On day 1, TIVA group patients demonstrated better cognitive scores than the inhalational group. On days 3 and 7, no appreciable changes were noted. By day 7, both groups showed notable cognitive improvement over preoperative levels.
Conclusion: Though by day seven they recover, both TIVA and inhalational anesthesia cause cognitive problems following surgery. Early after surgery, TIVA enhances cognitive ability; but both techniques have identical long-term results. Our results imply that to improve cognitive recovery, elderly surgical patients require specially tailored anesthetic management.
Abbreviations: MMSE: Mini-Mental State Examination, MoCA: Montreal Cognitive Assessment, POCD: Postoperative Cognitive Dysfunction, TIVA: total intravenous anesthesia,
Keywords: Total Intravenous Anesthesia; Inhalational Anesthesia; Postoperative Cognitive Dysfunction; Elderly Patients; Cognitive Recovery
Citation: Saeed AA, Al-Jenabi ZK. The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients. Anaesth. pain intensive care 2025;29(2):226-231.
Received: September 02, 2024; Reviewed: October 23, 2024; Accepted: January 01, 2025
