Effects Of Two Different Methods Of General Anesthesia On Early Postoperative Cognitive Function In Patients Undergoing Maxillofacial Surgery

ObjectiveTo observe and compare the effects of early postoperative cognitive function with two different methods of general anesthesia in young patients undergoing maxillofacial surgery,and to offer clinical referrance.MethodsSixty patients(23 male and37 female),aged 18～39years,ASAⅠ～Ⅱ,scheduled for oral and maxillofacial surgery,were randomly divided into two groups:total intravenous anesthesia group(groupâ… );intravenous-inhalation combined anesthesia group(groupâ…¡).Patients in groupâ… received target-controlled infusion with remifentanil 0.2～0.5pμg·kg^-1·min^-1and propofol 6～8mg·kg^-1·h^-1;Patients in groupâ…¡received target-controlled infusion with remifentanil 0.2～0.25μg·kg^-1·min^-1and inhalated sevofluranel.7～2.2%for maintenance.Hernodynamic parameters were continuously monitored,MAP(mean artery pressur) and HR(heart rate) were recorded at four time points including 5 min after entering operation room(T₀),intubation (T₁),operation beginning(T₂),extubation(T₃).Anesthesia and operation durations,time of eye opening,extubation,response to commands and orientation.To assess cognitive function using Mini-Mental State Examination(MMSE),in different time points of preoperative,1 day and 3,7 day postoperatively.Results(1).There were no significant difference in MAP(mean artery pressur) and HR(heart rate) at every time points(P＞0.05)between groupâ… and groupâ…¡.(2).The time of response to commands and orientation in groupâ… were significantly shorter than that in groupâ…¡(P＜0.05),The time of eye opening and extubation were similar in the two groups(P＞0.05).(3).The incidence of postoperative nausea and vomiting were similar in both groups(groupâ… ,1;groupâ…¡,2).No shivering and other complicatio happened in the two groups after operation.(4).MMSE scores were similar preoperatively and 3 day after operation(P＞0.05) while MMSE scores were sligtly lower in both groups on day 1 after operation than those preoperative,MMSE scores were slightly higher in both groups on day 7 after operation than those preoperative,MMSE scores were similar at every time points between the two groups(P＞0.05).(5).The percentage of the patients who developed postoperative cognitive dysfunction(POCD) in groupâ… were 3.33%on day 1 after operation;while the incidence of POCD in groupâ…¡were 6.67%at the same time point.The incidence of POCD in groupâ… was appreciably lower than that in groupâ…¡(P＞0.05).The total incidence of POCD on day 1 after operation were 5.0%.Conclusion(1).Using MMSE to assess cognitive function,tota lintravenous anesthesia(with remifentanil/propofol) and intravenous-inhalation combined anesthesia(with sevoflurane/remifentanil) may affect early postoperative cognitive function of patients aged 18～39years,undergoing maxillofacial surgery in different extent,and may induce POCD transiently.(2).POCD induced by total intravenous anesthesia(with remifentanil/propofol) is appreciably less than that by intravenous-inhalation combined anesthesia(with sevoflurane/remifentanil).