Effects Of Desflurane And Propofol On Stress Response And Postoperative Delirium In Elderly Patients

Objective:To investigate the effects of desflurane intravenous inhalation combined anesthesia and propofol total intravenous anesthesia on stress response and postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy.A total of 74 patients aged 60-70 years undergoing laparoscopic cholecystectomy with ASA I-II were randomly divided into desflurane group?group D?and propofol group?group B?with 37 cases in each group.Patients in both groups were induced by propofol TCI anesthesia.Anesthesia was maintained by desflurane inhalation and remifentanil intravenous pumping in group D,propofol target-controlled infusion and remifentanil pumping maintained anesthesia in group B.During the anesthesia,the entropy index?Entropy Index,En?was used to continuously monitor the depth of anesthesia,and the En was maintained between 45 and 55.Surgery begins at 8:30 to 9:00 in the morning.The systolic blood pressure/diastolic blood pressure and heart rate were recorded at resting ten minutes?T₁?,intubation?T₂?,pneumoperitoneum for twenty minutes?T₃?,end of operation?T₄?,tracheal extubation?T₅?and ten minutes after extubation?T₆?.Extubation time and departure time were recorded.Venous blood samples were taken from patients at T_1,T₃and T₆ time points,and blood glucose and cortisol concentration were measured.The patients in the two groups were followed up at 1,3,6,24and 48 hours after operation.The postoperative delirium was assessed by the Chinese revised version of delirium rating scale?CAM-CR?.The number of cases of delirium within 48 hours after operation and the incidence of postoperative delirium were recorded.The postoperative pain score?assessed by visual analog scale?VAS??,postoperative agitation,postoperative nausea and vomiting were recorded in the two groups.Results:The systolic blood pressure at T₃,diastolic blood pressure at T₄ and heart rate at T₃ and T₄ in group D were significantly higher than those in group B?P<0.05?.There was no significant difference in systolic blood pressure,diastole blood pressure and heart rate between the two groups?P>0.05?.Stress index:the concentration of blood glucose and cortisol at T₃ and T₆ in group D was significantly lower than that in group B?P<0.05?,and there was significant difference between the two groups?P<0.05?.There was no difference in the incidence of postoperative delirium between the two groups?P>0.05?.The extubation time and departure time in group D were significantly shorter than those in group B?P<0.05?.There was no significant difference in postoperative pain,postoperative agitation,postoperative nausea and vomiting between the two groups?P>0.05?.Conclusion:Desflurane can reduce stress response more effectively than propofol.The effects of desflurane and propofol on postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy are basically similar.