Effect of propofol-based total intravenous anaesthesia on postoperative cognitive function and sleep quality in elderly patients

The effect of intravenous and inhalation anesthesia in general on the cognition of elderly patients undergoing non-cardiac surgery: a systematic review and meta-analysis

Background

Postoperative cognitive dysfunction (POCD) is a postoperative complication that often occurs in the elderly. This systematic review and meta-analysis aimed to compare intravenous anesthetics (propofol) with inhalation anesthetics (sevoflurane) regarding the occurrence of POCD in the elderly who underwent non-cardiac surgery.

Methods

The investigators searched for published articles from the PubMed, Embase, Web of Science, Scopus, Cochrane, and Clinicalkey databases. Clinical studies comparing the incidence of POCD in elderly patients undergoing intravenous or inhalation anesthesia in general were selected. Primary outcomes included the occurrence of POCD at 1, 3, and 7 days. The secondary outcomes were the patient's plasma S-100β protein levels (pg*mL-1) and delayed neurocognitive recovery incidence 5-7 days after surgery.

Results

Fifteen studies including 3,817 patients were enrolled in the systematic review. Ten studies involving 1,829 patients were enrolled in the meta-analysis. The results demonstrate that there was no difference between the intravenous and inhalation groups in the incidence of POCD within 1-7 days (95% CI 0.73-1.26, p = 0.77) and the occurrence of delayed neurocognitive recovery 5-7 days after surgery (95% CI -353.15 to -295.44, p = 0.28). Plasma S-100β protein levels in the intravenous anesthesia group were lower than those in the inhalation group (95% CI 0.48-1.24, p < 0.001).

Conclusion

For elderly patients undergoing non-cardiac surgery, inhalation anesthesia was comparable to intravenous anesthesia in terms of the occurrence of short-term POCD. Inhalation anesthesia may cause greater damage to the nervous system, with delayed recovery of cognitive function after 5-7 days showing no difference.

Systematic review

identifier (CRD42021251317).

Improved Pittsburgh Sleep Quality Index scores on first postoperative night achieved by propofol anesthesia in patients undergoing ambulatory gynecologic surgery

BACKGROUND

Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.

AIM

To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.

METHODS

We enrolled 61 American Society of Anesthesia (ASA) class I-II outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index (PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.

RESULTS

For the propofol group, the mean postoperative global PSQI score (3.3 ± 1.3) was lower than the mean preoperative global PSQI score (4.9 ± 2.3) (P < 0.001); for the sevoflurane group, the mean postoperative global PSQI score (6.5 ± 2.8) was higher than the mean preoperative global PSQI score (5.5 ± 3.2) (P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.

CONCLUSION

Sleep quality assessed by the PSQI is better improved in ASA class I-II female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.

Does propofol definitely improve postoperative cognitive dysfunction?-a review of propofol-related cognitive impairment

Postoperative cognitive dysfunction (POCD) is a common brain function-related complication after surgery. In addition to old age being an independent risk factor, anesthetics are also important predisposing factors. Among them, propofol is the most commonly used intravenous anesthetic in clinical practice. It has a rapid onset, short half-life, and high recovery quality. Many studies report that propofol can attenuate surgery-induced cognitive impairment, however, some other studies reveal that propofol also induces cognitive dysfunction. Therefore, this review summarizes the effects of propofol on the cognition, and discusses possible related mechanisms, which aims to provide some evidence for the follow-up studies.

The Impact of Morning Surgery or Afternoon Surgery on Postoperative Sleep Quality and Melatonin Levels of Elderly Patients: A Prospective, Randomized Study

OBJECTIVE

Postoperative sleep disturbance after surgery is not conducive to the recovery of patients. The purpose of this study was to determine the influence of the timing of surgery (morning vs afternoon) on the postoperative sleep quality of elderly patients and to analyze the relationship between the timing of surgery and the change in the melatonin level.

METHODS

Sixty patients who received hip surgery were randomly assigned to the Morning Group (Group M) or the Afternoon Group (Group A). The sleep quality was assessed by the Richards-Campbell Sleep Questionnaire. Before and after surgery, the nocturnal urine was collected over a 12-h period, and the 6-sulfatoxymelatonin concentration was measured. Also, the incidence of postoperative delirium (POD) was observed.

RESULTS

On the first and second nights after surgery, the sleep quality scores of the patients in Group A were greater than those in Group M, and there was no difference in the sleep quality scores between the two groups on the third night after surgery (P=0.000, P=0.002, P>0.05, respectively). In addition, the urine 6-sulphatoxymelatonin concentration was found to be greater in Group A than in Group M on the first night of surgery (P=0.00). Both the postoperative sleep quality scores and urine 6-sulphatoxymelatonin concentration were significantly less than those before surgery (P=0.00, P=0.00).

CONCLUSION

The postoperative sleep quality scores and melatonin levels of elderly patients who received hip surgery under general anesthesia were significantly less than those of the patients before surgery. Furthermore, the short-term sleep quality of the patients who received surgery in the afternoon was better than that of the patients who received surgery in the morning. This difference may be related to the short-term change of the melatonin level after surgery.