| Objective:To compare the effects among different combination with desflurane,sevoflurane,and propofol on postoperative cognitive function in school-age children,and provide clinical evidence for selecting a better pediatric anesthesia program.Methods:One hundred and fifty pediatrics,undergoing tonsillectomy and/or adenoidectomy,ASA Ⅰ～Ⅱ grade,aging 5～12 years old and the Peabody Picture Vocabulary Test score(PPVT score)≥90,without exposure to anesthetics,were randomly divided into the sevoflurane group(SS group),the sevoflurane+propofol group(SP group),the sevoflurane+desflurane group(SD group),the propofol group(PP group)and the propofol+desflurane group(PD group).Every group was 30 cases.Anesthesia induction:the SS group,SP group,and SD group were induced with 8%sevoflurane,the PP group and PD group were induced with propofol 2～2.5mg/Kg.After the pediatric fell asleep,the five groups all were injected with vecuronium bromide 0.10mg/kg and sufentanil 0.5μg/kg.After 3 minutes,the pediatrics was intubated under the eyesight,then underwent mechanical ventilation.Anesthesia maintenance:SS group was maintained with sevoflurane 1.3MAC(1%～4%),SD group and PD group were maintained with desflurane 1.3MAC(2%～6%),PP group and SP group were given propofol 4～12mg/kg·h.All pediatrics in the five groups were pumped with remifentanil 0.1～0.2μg/kg·min during the operation,stopped pumping remifentanil in 5 minutes before the end of the operation,and given sufentanil 0.05ug/Kg.Finally the sevoflurane or desflurane,propofol were stopped at the end of the operation.The Non-invasive blood pressure(NIBP),heart ratewas(HR),extubation time and incidence of nausea or vomiting were recorded during the operation and PACU stay.The serum concentrations of S100β protein and neuron-specific enolase(NSE),on 1 day before operation(T0)and 1 day after operation(T1),were detected by ELISA to evaluate the damage of nerve cells.The cognitive function was accessed with PPVT scores on the first day after operation and the Combined Raven’s Test(CRT)scores at 3 days after operation,1 month after operation and 3 months after operation.Results:1.There was no statistically significant difference in age,height,weight,sex,feeding methord,education time and operation time among the five groups.2.Hemodynamic changes:(1)Intergroup comparison:the SBP of the five group all were significantly lower than the basicline in 5 minutes after induction(P<0.05).There were no significant differences between the other time points and baseline in SBP(P>0.05);HR in the baseline were not significantly different from other time points in SS group and SD group(P>0.05);the HR at 5 minutes after induction and when entering PACU were significantly lower than the baseline in SP group.(P<0.05);the HR at 5 minutes after induction was significantly lower than the baseline in PP group and the PD group(P<0.05).Besides the time what have reffered,there was no significant difference between baseline with other time points in the HR for the five groups(P>0.05).(2)Comparison between groups:there were no significant differences in the SBP between the five groups at baseline,induction,5minutes after induction,5minutes after intubation,5minutes after surgery,5minutes after surgery,and PACU(P>0.05);the SBP of SP group at 5 minutes after extubation was significantly higher than that in the PP group(P<0.05).The SBP in PD group was significantly higher than that in the PP group(P>0.05).;There were not significantly differences between the five groups in the SBP when out of PACU(P<0.05);there were no statistically significant difference in HR between the five groups at each time points.3.Extubation time and incidence of postoperative nausea and vomiting:extubation time in desflurane maintenance group(SD group,PD group)was significantly lower than that in propofol maintenance group(SP group,PP group)and sevoflurane maintenance group(SS group)(P<0.05),but there was no significant difference in extubation time between sevoflurane maintenance group(SS group)and propofol maintenance group(SP group,PP group)(P>0.05).There was no significant difference in the incidence of nausea and vomiting among the five groups(P>0.05).4.Serum S100β protein:there was no significant difference in serumS100β concentration of the five groups between T0 and T1(P>0.05),and there was no significant difference between the five groups(P>0.05).5.Serum NSE:The concentration of serum NSE in T1 was significantly higher than that on T0(P<0.05),but there was no significant difference between the five groups(P>0.05).6.PPVT score:There were no significant difference in PPVT score of the five groups between the 1 day before operation and the 1 day after operation(P>0.05).There were no significant difference between the five groups(P>0.05).7.CRT scores and CRT answer time:there were no significant difference in CRT score of the five group between the different time points after operation(P>0.05).There were no significant difference in CRT score between the five groups at 3 days,1 month and 3 months after operation(P>0.05).The CRT answer time on 1 month after operation was significantly less than that at 3 days and 3 months after operation(P<0.05).There were no significant difference in the CRT answer time between the five groups at 3 days,1 month and 3 months after operation(P>0.05).Conclusions:The different ways that combined desflurane,sevoflurane,and propofol did not affect the postoperative cognitive function of school-age pediatrics who underwent a short-term operation in three month after operation. |
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