Effect of desflurane and sevoflurane on postoperative cognitive dysfunction： A meta-analysis of randomized controlled trials

Background This meta-analysis was conducted to evaluate the effects of desflurane and sevoflurane on postoperative cognitive dysfunction(POCD). Methods Randomized controlled trials (RCTS) investigating the application of desflurane and sevoflurane in the maintenance of POCD in patients under general anesthesia were retrieved through a computer search on the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure(CNKI), Wanfang Database and Technology Periodical Database (VIP) for studies published until October 2022. The identified literature were analyzed using the Revman5.3 system evaluation software. Results A total of 10 studies met the inclusion criteria, which comprised 966 patients, including 483 in the desflurane group and 483 in the sevoflurane group. It was observed that the score of Mini-Mental State Examination (MMSE) decreased preoperative (SMD = 0.00, 95%CI = -0.14-0.15), 1h after surgery (SMD = 1.78, 95%CI = 0.68–2.88), and 3h after surgery (SMD = 0.46, 95%CI = 0.09 ~ 0.82), 6h after surgery (SMD = 1.11, 95%CI =-0.15 ~ 2.37), and 24h after surgery (SMD = 0.16, 95%CI =-0.01 ~ 0.30), and eye opening time (SMD = -3.30, 95%CI = -4.65-1.96) and extubation time (SMD = -3.54, 95%CI = -5.44-1.63) in desflurane group were shorter compared with values in the sevoflurane group. Conclusions Desflurane results in shorter eye opening and extubation times compared with sevoflurane when used as the maintenance therapy of general anesthesia with inhalation anesthetics. Both anesthetics may lead to a reduction in cognitive function among surgical patients, and this is particularly higher the sevoflurane than for desflurane treatment. Registration number: CRD42023390692.