No Difference in Early Post Operative Cognitive Dysfunction after Abdominal Surgery with Sevoflurane or Propofol Based General Anesthesia

Background: There is an increasing need to investigate the influence of anesthetics on post-operative cognitive dysfunction (POCD), probably resulting from concurring perioperative stress factors. This study aimed to seek a difference in early POCD after general anesthesia with either propofol or sevoflurane as maintenance agent in patients undergoing abdominal surgery. Methods: Patients older than 60, undergoing general anesthesia for laparotomic abdominal surgery with Sevoflurane/air or Propofol Target Controlled Infusion were included in this observational study. Working and long term memory, attentive capacity and correct reading velocity were evaluated before and 1 week after surgery. POCD was detected from the difference between postoperative and baseline performances, subtracting the learning effect observed in a control group. Results: Of 92 patients included, 25 received propofol and 67 sevoflurane. Overall POCD incidence was 14.14%. POCD was 12.00% in propofol group and 14.93% in sevoflurane group (P = 0.72). There was no significant association between age, sex, duration of surgery or anesthesia and POCD occurrence (P > 0.05). Lower education level (OR = 3.74; 95% CI: 0.78 – 18.04; P > 0.05) and overall pain as referred by patients at 7th day (OR = 1.33; 95% CI: 1.02 – 1.75; P = 0.029) had a high odd of POCD. Conclusion: Our results indicate no preference between sevoflurane or propofol in order to obtain a better early neurocognitive outcome. Pain was associated to POCD generation. In order to verify or exclude anesthetic toxicity, ongoing prospective studies in humans including dosage of neuronal death markers could be useful.