Effects Of Propofol On Early Postoperative Cognitive Function And Inflammatory Cytokines In The Elderly

Objective:To explore the effectsof propofol on early postoperative cognitive function and inflammatory cytokines in the elderly and it's possible mechanic.Mothod: Sixty ASAⅠ~Ⅱelderly patients undergoing gastric cancer surgery were randomly divided into two groups, sevoflurane inhalation anesthesia group(groupⅠ)and propofol total intravenous anesthesia group(groupⅡ).Sevoflurane inhalation induction and maintenance were applied in groupⅠ; TCI of propofol induction and maintenance were used in groupⅡ. Preoperative﹑intraoperative and postoperative hemodynamic parameters were recorded in two groups, as well as operating time,recovery time,blood loss,urine output,fluid volume and the BIS values. Peripheral venous blood were respectively collected in times of before induction of anesthesia,4h after beginning of operation,4h and 48h postoperatively. Serum concentration of IL-1β﹑IL-6﹑TNF-a﹑IL-10 were measured by ELISA. The Wechsler Memory Scale and Wechsler Adult intelligence Scale were evaluated in two groups preoperatively and 2 days after operation.Result: There was no significant difference between two groups at the general aspects of preoperation,intraoperation and postoperation (p > 0.05). The concentration of IL-1β﹑IL-6﹑TNF-a﹑IL-10 at T1,T2,T3 in both groups were higher than that at T0 (P<0.05). Between the two groups, there was no significant difference in four kinds of cytokines at T0,as well as IL-1βat the T1,T2,T3 (P>0.05); The concentration of IL-6﹑IL-10 in groupⅡwas lower than that in groupⅠat T1,T2,T3 (P<0.05); The concentration of TNF-a in groupⅡwas lower than that in groupⅠat T1,T2 (P<0.05),and no significant difference was found at T3 between two groups. In the test of neuropsychological function , the postoperative scores of Visual Regeneration test were lower than that preoperatively in both groups (P<0.05),the scores of postoperative Associative Learning﹑Acumulation test in both groups were lower than that preoperatively (P<0.05). The postoperative scores of Digit Span Test in groupⅠwere lower than that preoperatively(P<0.01) , there was no significant difference in groupⅡbetween preoperation and postoperation (P>0.05). Significant difference were found in two groups in the comparison of the difference of Acumulation﹑Associative Learning﹑Digit Span Test scores between preoperation and postoperation(P<0.05). The incidence of POCD was 23.33% in groupⅠa nd 13.33% in groupⅡ, there was no significant difference between two groups (P>0.05). Positive correlation were found between an elevation in IL-6 levels 4h after operation and the decline of postoperative memory function score(such as accumulation, associative learning, visual regeneration, digit span test)Conclusion: Positive correlation were found between an early elevation in IL-6 levels and the decline of postoperative memory function . propofol can reduce the release of of early postoperative The decrease of inflammatory cytokines and the increase of anti-inflammatory cytokines by propofol can improve the decline of postoperative memory function in the elderly.Though propofol can not obviously reduce the incidence of postoperative cognitive dysfunction, it can be used as the first choice of general anesthesia medication for the elderly .