Effect of sevoflurane post-conditioning on postoperative cognitive function in carotid endarterectomy patients: a randomized, double-blind, controlled trial

Purpose This study evaluated the effect of low-dose sevoflurane post-conditioning on early neurocognitive recovery in patients aged 50–80 years undergoing carotid endarterectomy (CEA). Methods In this randomized, double-blind, single-center trial, 71 patients undergoing elective CEA receiving either sevoflurane post-conditioning (Group S, n = 36) or standard propofol-based anesthesia (Group P, n = 35) were analysed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline, and on postoperative days 1 and 3. The primary outcome was the change in cognitive scores from baseline. Results The two-way repeated-measures ANOVA revealed a significant main effect of group for both MMSE ( p < 0.001) and MoCA ( p = 0.019) scores. As the groups were comparable at baseline, this difference emerged postoperatively, driven by divergent outcomes on day 1: the propofol group (Group P) experienced a significant change in cognitive scores from baseline in both MMSE (−0.97 ± 1.81) and MoCA (−0.80 ± 1.83), whereas the scores in the sevoflurane group (Group S) were preserved in both MMSE (+0.58 ± 1.76) and MoCA (+0.81 ± 2.59). A significant between-group difference was therefore evident on postoperative day 1 (MMSE p = 0.002; MoCA p = 0.037) and was maintained on postoperative day 3 (MMSE p = 0.023; MoCA p = 0.036). Conclusion Low-dose sevoflurane post-conditioning provides superior short-term preservation of cognitive function compared to standard anesthesia in patients undergoing CEA. These findings support the potential neuroprotective role of sevoflurane post-conditioning. Further research is warranted to explore long-term outcomes that incorporate biological sample testing. Clinical trial registration https://ClinicalTrials.gov , NCT04950205.