PDF(Pubmed)
Abstract：
The present prospective randomized study was designed to investigate whether the development of Post Operative Cognitive Decline (POCD) is related to anesthesia type in older adults. All patients were screened for delirium and mental status, received baseline neuropsychological assessment, and evaluation of activities of daily living (ADLs). Follow-up assessments were performed at 3-6 months and 12-18 months. Patients were randomized to receive either inhalation anesthesia (ISO) with isoflurane or total intravenous anesthesia (TIVA) with propofol for maintenance anesthesia. ISO (n = 99) and TIVA (n = 100) groups were similar in demographics, preoperative cognition, and incidence of post-operative delirium. Groups did not differ in terms of mean change in memory or executive function from baseline to follow-up. Pre-surgical cognitive function is the only variable predictive of the development of POCD. Anesthetic type was not predictive of POCD. However, ADLs were predictive of post-operative delirium development. Overall, this pilot study represents a prospective, randomized study demonstrating that when examining ISO versus TIVA for maintenance of general anesthesia, there is no significant difference in cognition between anesthetic types. There is also no difference in the occurrence of postoperative delirium. Postoperative cognitive decline was best predicted by lower baseline cognition and functional status.
摘要：
本前瞻性随机研究旨在研究老年人术后认知功能下降（POCD）的发展是否与麻醉类型有关。所有患者均进行谵妄和精神状态筛查,接受基线神经心理学评估，和日常生活活动(ADL)的评估。在3-6个月和12-18个月进行随访评估。患者随机接受异氟醚吸入麻醉（ISO）或异丙酚全静脉麻醉（TIVA）维持麻醉。ISO（n=99）和TIVA（n=100）组在人口统计上相似，术前认知,术后谵妄的发生率。从基线到随访，各组在记忆或执行功能的平均变化方面没有差异。术前认知功能是预测POCD发展的唯一变量。麻醉类型不能预测POCD。然而,ADLs可预测术后谵妄的发展。总的来说,这项试点研究代表了一个前瞻性的，随机研究表明，在检查ISO和TIVA以维持全身麻醉时，麻醉类型之间的认知没有显着差异。术后谵妄的发生也没有差异。术后认知下降最好通过较低的基线认知和功能状态来预测。
