Key result
Isoflurane anesthesia was associated with a significantly higher incidence of postoperative cognitive dysfunction compared to sevoflurane in patients undergoing major cardiac surgery (OR 2.27 at day 1).
Why the study?
Postoperative cognitive dysfunction is associated with low quality of life after major cardiac surgeries, but the impact of inhaled anesthesia is not well established.
Does sevoflurane reduce the incidence of postoperative cognitive dysfunction compared to isoflurane in patients undergoing major cardiac surgeries?
Cohort (n=254)
Single-blind
No
Does sevoflurane reduce the incidence of postoperative cognitive dysfunction compared to isoflurane in patients undergoing major cardiac surgeries?
Odds Ratio: 2.27 (95% CI 1.94–2.65)
Absolute Event Rate: 66% vs 48%
p-value: p=<0.0001
Sevoflurane is associated with a lower incidence of early postoperative cognitive dysfunction compared to isoflurane in patients undergoing major cardiac surgery.
Sevoflurane may lower early POCD risk versus isoflurane after cardiac surgery; hypothesis-generating and requires randomized confirmation before practice change.
Background: Postoperative cognitive dysfunction is a complication associated with low quality of life in patients receiving major cardiac surgeries. Postoperative cognitive dysfunction due to inhaled anesthesia is not well established. The objective of the present study was to compare the incidence of postoperative cognitive dysfunction in patients undergoing major cardiac surgeries anesthetized with isoflurane or sevoflurane. Materials and Methods: The observational study conducted in a teaching hospital to compare the incidence of postoperative cognitive dysfunction as assessed by Mini-Mental State Examination (MMSE) in patients undergoing major cardiac surgery who received isoflurane or sevoflurane. MMSE was administered preoperatively (D0), postoperative day 1 (D1), postoperative day 3 (D3) and postoperative day 5 (D5) to assess cognitive performance. An MMSE score of < 24 or a difference greater than 3 as compared to preoperative score was considered as postoperative cognitive dysfunction. Results: A total of 254 patients (126 patients on isoflurane and 128 patients on sevoflurane) were included in the analysis. At D0, MMSE scores were not significantly different between patients who received sevoflurane and who received isoflurane (p=0.191). The incidence of postoperative cognitive dysfunction was higher in the isoflurane group at all postoperative assessments compared to sevoflurane group (p<0.05 for all). Conclusion: Sevoflurane has fewer chances of incidences of postoperative cognitive dysfunction than isoflurane.
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Peng et al. (2019) conducted a cohort in Postoperative cognitive dysfunction (n=254). Isoflurane vs. Sevoflurane was evaluated on Incidence of postoperative cognitive dysfunction (MMSE score < 24) at postoperative day 1 (OR 2.27, 95% CI 1.94-2.65, p=<0.0001). Isoflurane anesthesia was associated with a significantly higher incidence of postoperative cognitive dysfunction compared to sevoflurane in patients undergoing major cardiac surgery (OR 2.27 at day 1).
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