Comparison of postoperative cognitive dysfunction with the use of propofol versus desflurane in patients undergoing surgery for clipping of aneurysm after subarachnoid hemorrhage.
Comparison of postoperative cognitive dysfunction with the use of propofol versus desflurane in patients undergoing surgery for clipping of aneurysm after subarachnoid hemorrhage.
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DOI：
10.25259/sni_70_2020
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Bhagat, Hemant
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文献类型：
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作者：
Sharma, Nanish;Wig, Jyotsna;Bhagat, Hemant
背景：脑动脉瘤破裂是脑血管意外的一种特殊原因。尽管目前的概念是早期手术夹闭，以防止动脉瘤破裂的后果，在良好的等级蛛网膜下腔出血患者，40-50%的术后认知功能障碍（POCD）的长期基础上。在这里，我们比较了两种常用麻醉剂对脑卒中手术后认知功能的影响，即，异丙酚和地氟烷。方法：我们对70例随机接受丙泊酚或地氟烷维持麻醉剂的患者进行了前瞻性双盲临床研究。在出院时或手术后2周（以较早者为准），使用印地语版本的蒙特利尔认知评估量表研究患者的认知功能。结果：两种麻醉药在出院时和术后2周POCD的发生率（65.4% vs.82.6%，P > 0.05）无显著性差异。丙泊酚组和地氟烷组的平均POCD评分分别为22.81 ± 4.45和19.09 ± 5.66，具有统计学意义（P值-0.01）。异丙酚组的执行功能、注意力和定向力评分优于地氟醚组。术中血流动力学和脑松弛评分相似，在这两个group.CONCLUSION：一个显着的患者接受颈动脉瘤手术经历POCD，虽然发病率仍然相似，在两组。然而，在出院时或术后2周（以较早者为准），与地氟烷相比，使用丙泊酚似乎能更好地保持平均认知评分和某些认知功能领域，尤其是执行功能、注意力和定向力。
BACKGROUND: Cerebral aneurysm rupture is a distinct entity among various causes of cerebrovascular accident. Despite the current concept of early surgical clipping to prevent consequences of ruptured aneurysm in good grade subarachnoid hemorrhage patients, 40-50% have postoperative cognitive dysfunction (POCD) on a long- term basis. Here, we compared the effect of two commonly used anesthetic agents on cognitive function following cerebral aneurysmal surgery, i.e., propofol and desflurane.METHODS: We conducted a prospective double-blind clinical study in 70 patients who were randomized to receive maintenance anesthetic agents either propofol or desflurane. The cognitive functions of patients were studied at the time of the discharge from a hospital or at 2 weeks following surgery whichever was early using the Hindi version of the Montreal Cognitive Assessment scale. The hemodynamic parameters, brain relaxation score at the different time intervals, were also studied.RESULTS: There was no difference between the two anesthetic agents in terms of incidence of POCD (65.4% vs. 82.6%, P > 0.05) at the time of discharge or at 2 weeks following surgery. The mean POCD score in propofol and desflurane group was 22.81 ± 4.45 and 19.09 ± 5.66 which was statistically significant (P-value-0.01). The scores for domains of executive function, attention, and orientation were better with propofol group than desflurane group. Intraoperative hemodynamics and brain relaxation scores were similar in both groups.CONCLUSION: A significant number of patients undergoing aneurysmal neck surgery experienced POCD although incidence remained similar in both groups. However, it appears that mean cognitive score and certain domains of cognitive functions especially the executive function, attention, and orientation were better preserved with the use of propofol when compared to desflurane at the time of discharge or on 2 weeks following surgery whichever was early.