Key result
Intravenous propofol and inhalational sevoflurane resulted in comparable short-term postoperative cognitive outcomes at 24 hours in pediatric patients undergoing general anesthesia.
Why the study?
Does intravenous propofol compared to inhalational sevoflurane improve short-term postoperative cognitive outcomes in pediatric patients undergoing general anesthesia?
RCT (n=80)
Alternate basis
No
Does intravenous propofol compared to inhalational sevoflurane improve short-term postoperative cognitive outcomes in pediatric patients undergoing general anesthesia?
Absolute Event Rate: 10.63% vs 11.45%
p-value: p=0.110
In pediatric patients undergoing general anesthesia, maintenance with either propofol or sevoflurane results in similar transient cognitive decline at 6 hours that resolves by 24 hours.
Propofol and sevoflurane show comparable short-term cognitive recovery in children; leaves open questions on longer-term effects and larger trials.
Postoperative cognitive dysfunction (POCD) is a newly diagnosed subtle impairment of memory, concentration, and speed of information processing after surgery. POCD in adults and geriatric population has been well established, but less explored in the paediatric age group. The aim of this study is to compare the effects of intravenous propofol and inhalational sevoflurane on short term postoperative cognitive outcomes in children. Experimental approach: 80 paediatric patients aged 5 - 15 years of ASA grade I and II posted for surgeries under general anaesthesia except neurosurgery were randomly allocated into two groups with 40 patients in each group. Group A received intravenous propofol and Group B received inhalational sevoflurane for maintenance of general anaesthesia. Cognitive assessment tests were done using Wechsler's Intelligence Scale for Children (WISC-V) both preoperatively and postoperatively at 6hr, 12hr and 24hr respectively. Major Findings: Comparison of various cognitive indices in Group A and B is significantly lower at 6 hours in comparison to the preoperative value. Comparison of various cognitive indices between preoperative and at 24 hours postoperative levels, in Group A and B showed that these parameters return to the preoperative state at 24 hours after surgery.Conclusion: There is no significant postoperative cognitive decline in patients comparing the cognitive functions preoperatively and 24 hour postoperative levels when using intravenous propofol versus inhalational sevoflurane. There was a transient but significant decline noted in the cognitive functions at 6 hour postoperatively compared to the preoperative period, noticed equally with both groups.
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Jain et al. (2021) conducted an RCT in Pediatric patients undergoing non-neurosurgical procedures under general anesthesia (n=80). Intravenous propofol vs. Inhalational sevoflurane (1-3% end-tidal concentration) was evaluated on Visual Spatial Index (VSI) at 24 hours postoperatively (p=0.110). Intravenous propofol and inhalational sevoflurane resulted in comparable short-term postoperative cognitive outcomes at 24 hours in pediatric patients undergoing general anesthesia.
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