The recovery of cognitive function after general anesthesia in elderly patients: A comparison of desflurane and sevoflurane
The recovery of cognitive function after general anesthesia in elderly patients: A comparison of desflurane and sevoflurane
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DOI：
10.1097/00000539-200112000-00029
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发表时间：
2001-12-01
影响因子：
5.7
通讯作者：
Norel, E
中科院分区：
文献类型：
--
作者：
Chen, XG;Zhao, MX;Norel, E
我们评估了老年患者在地氟醚或七氟醚全麻后的认知恢复情况。IRB批准后，70例阿萨身体状况I-III级同意接受全膝关节或髋关节置换术的老年患者（≥ 65岁）被随机分配到两个全身麻醉组之一。使用丙泊酚和芬太尼进行麻醉诱导，然后使用2%-4%地氟烷或1%-1.5%七氟烷和65%笑气。地氟烷（2.5 +/- 0.6 MAC . h）和七氟烷（2.7 +/- 0.5 MAC - h）浓度进行调整，以使用脑电图双频谱指数监测器维持可比的催眠深度。术前和术后1、3、6、24 h分别采用简易精神状态（MMS）测试评估患者的认知功能。地氟烷的使用与更快的麻醉苏醒（6.3 +/- 2.4 min vs 8.0 +/- 2.8 min）和更短的麻醉后监护室停留时间（213 +/- 66 min vs 241 +/- 87 min）相关。然而，当比较术前和术后1、3、6和24 h的MMS评分时，地氟烷组和七氟烷组之间无显著差异。与术前（基线）MMS评分相比，术后1小时的数值显著降低（地氟烷组分别为27.8 +/- 1.7与29.5 +/- 0.5，七氟烷组分别为27.4 +/- 1.7与29.2 +/- 1.0）。然而，MMS评分在术后6小时内恢复至术前基线水平。在术后1小时和3小时，地氟烷组（与七氟烷组相比）中51%和11%（与57%和9%）的患者发生认知障碍。总之，地氟烷与老年患者全麻后比七氟烷更快的早期恢复相关。然而，地氟烷和七氟烷麻醉后认知功能的恢复相似。
We evaluated the cognitive recovery profiles in elderly patients after general anesthesia with desflurane or sevoflurane. After IRB approval, 70 ASA physical status I-III consenting elderly patients (greater than or equal to 65 yr old) undergoing total knee or hip replacement procedures were randomly assigned to one of two general anesthetic groups. Propofol and fentanyl were administered for induction of anesthesia, followed by either desflurane 2%-4% or sevoflurane 1%-1.5% with nitrous oxide 65% in oxygen. The desflurane (2.5 +/- 0.6 MAC . h) and sevoflurane (2.7 +/- 0.5 MAC - h) concentrations were adjusted to maintain comparable depths of hypnosis using the electroencephalogram bispectral index monitor. The Mini-Mental State (MMS) test was used to assess cognitive function preoperatively and postoperatively at 1, 3,6, and 24-h intervals. The use of desflurane was associated with a more rapid emergence from anesthesia (6.3 +/- 2.4 min versus 8.0 +/- 2.8 min) and a shorter length of stay in the postanesthesia care unit (213 +/- 66 min versus 241 +/- 87 min). However, there were no significant differences between the Desflurane and the Sevoflurane groups when the MMS scores were compared preoperatively, and postoperatively at 1, 3,6, and 24 h. Compared with the preoperative (baseline) MMS scores, the values were significantly decreased at 1 h postoperatively (27.8 +/- 1.7 versus 29.5 +/- 0.5 in the Desflurane group, and 27.4 +/- 1.7 versus 29.2 +/- 1.0 in the Sevoflurane group, respectively). However, the MMS scores returned to preoperative baseline levels within 6 h after surgery. At 1 h and 3 h after surgery, 51% and 11% (versus 57% and 9%) of patients in the Desflurane (versus Sevoflurane) Group experienced cognitive impairment. In conclusion, desflurane is associated with a faster early recovery than sevoflurane after general anesthesia in elderly patients. However, recovery of cognitive function was similar after desflurane and sevoflurane-based anesthesia.