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Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial.
Can J Anaesth. 2016 Oct; 63(10):1161-9.CJ

Abstract

PURPOSE

One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery.

METHODS

There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD.

RESULTS

Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD.

CONCLUSIONS

No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. (

REGISTRATION NUMBER

UMIN 000002826).

Authors+Show Affiliations

Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. junji-egawa@naramed-u.ac.jp.Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27412465

Citation

Egawa, Junji, et al. "Effects of Anesthetics On Early Postoperative Cognitive Outcome and Intraoperative Cerebral Oxygen Balance in Patients Undergoing Lung Surgery: a Randomized Clinical Trial." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 63, no. 10, 2016, pp. 1161-9.
Egawa J, Inoue S, Nishiwada T, et al. Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial. Can J Anaesth. 2016;63(10):1161-9.
Egawa, J., Inoue, S., Nishiwada, T., Tojo, T., Kimura, M., Kawaguchi, T., Taniguchi, S., Furuya, H., & Kawaguchi, M. (2016). Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 63(10), 1161-9. https://doi.org/10.1007/s12630-016-0700-4
Egawa J, et al. Effects of Anesthetics On Early Postoperative Cognitive Outcome and Intraoperative Cerebral Oxygen Balance in Patients Undergoing Lung Surgery: a Randomized Clinical Trial. Can J Anaesth. 2016;63(10):1161-9. PubMed PMID: 27412465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial. AU - Egawa,Junji, AU - Inoue,Satoki, AU - Nishiwada,Tadashi, AU - Tojo,Takashi, AU - Kimura,Michitaka, AU - Kawaguchi,Takeshi, AU - Taniguchi,Shigeki, AU - Furuya,Hitoshi, AU - Kawaguchi,Masahiko, Y1 - 2016/07/13/ PY - 2016/01/18/received PY - 2016/07/06/accepted PY - 2016/05/31/revised PY - 2016/7/15/entrez PY - 2016/7/15/pubmed PY - 2017/3/24/medline SP - 1161 EP - 9 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 63 IS - 10 N2 - PURPOSE: One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery. METHODS: There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD. RESULTS: Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD. CONCLUSIONS: No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. ( REGISTRATION NUMBER: UMIN 000002826). SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/27412465/Effects_of_anesthetics_on_early_postoperative_cognitive_outcome_and_intraoperative_cerebral_oxygen_balance_in_patients_undergoing_lung_surgery:_a_randomized_clinical_trial_ L2 - https://doi.org/10.1007/s12630-016-0700-4 DB - PRIME DP - Unbound Medicine ER -