Effect Of Sevoflurane And Propofol On Postoperative Cognitive Dysfunction In Cardiac Surgery Patients Undergoing Cardiopulmonary Bypass

Objective To investigate the effect of inhalation anesthesia with sevoflurane and propofol based total intravenous anesthesia on postoperative cognitive dysfunction in cardiac surgery patients undergoing cardiopulmonary bypass?CPB?.Methods 50 patients were scheduled for the cardiac surgery undergoing CPB,aged?40years,ASA?or?were enrolled in our study.Random number table method was used to divide the patients into two groups which each group had 25 patients.Patients in the sevoflurane group?S group,were given the continuous inhalation of sevoflurane 2%-2.5%?.Patients in the propofol group(P group,were given the continuous intravenous infusion of propofol 4-8mg·?kg·h?^-1).The BIS values were used to monitor the depth of anesthesia.The BIS values of the two groups were maintained at 40-60.The Montreal Cognitive Assessment?MOCA?was used to assess the postoperative cognitive dysfunction to observe the effect of propofol and sevoflurane in the incidence of POCD on day before operation and on the first,third and seventh day after operation.We recorded the perioperative hemodynamic parameters and total time duration of anesthesia,operation,CPB,ICU stay,mechanical ventilation,hospitalization as well as total cost of hospitalization.Serum S-100 beta protein and IL-6levels were measured by ELISA before operation?T₁?,at the end of CPB?T₂?and 24 hours after operation?T₃?.Results There were no significant difference in age,sex,ASA grade,BMI,NYHA grade and operative type between the two groups?P>0.05?.Compared with group P,the incidence of POCD in group S was higher on the third day after operation?P<0.05?.There were no significant difference in the incidence of POCD on the first and seventh post operative day in both groups?P>0.05?.There were no significant difference in operation time,anesthesia time,CPB time and mechanical ventilation time between the two groups?P>0.05?.The ICU stay time,hospitalization days and total hospitalization costs were less in group S,but there was no significant difference between the two groups?P>0.05?.There was no significant difference in perioperative hemodynamics between the two groups at different time points?P>0.05?.There was no significant difference in the concentration of IL-6 and S-100beta between the two groups at T1 time point?P>0.05?.At T2 and T3 time points,the concentration of IL-6 in group S was higher than that in group P?P<0.05?.Compared with T1 time point,the concentration of IL-6 increased at T2 and T3 time points in both groups,and the difference was statistically significant?P<0.05?.There was no significant difference in the concentration of S-100beta between the two groups?P>0.05?.Compared with the time point of T1,the concentration of S-100beta in group S increased at the time point of T2?P<0.05?.Conclusion The propofol based total intravenous anesthesia in cardiac surgery undergoing cardiopulmonary bypass has less incidence rate of early POCD,and inhibits the release of pro-inflammatory cytokine IL-6 is better than inhalation anesthesia with sevoflurane.