The Effects Of Desflurane On Postoperative Delirium And Sleep After Laparoscopic Colorectal / Rectal Cancer Radical Surgery In Elderly

Objective:To compare the effects of desflurane and sevoflurane on the incidence of postoperative delirium(POD)and the postoperative sleep quality in elderly patients undergoing laparoscopic colon / rectal cancer radical surgery.Methods:This study is a single center,randomized,controlled,double-blind trial.Patients aged 65-85 years undergoing laparoscopic colon / rectal cancer radical surgery in Wuhan Central Hospital were selected and randomly divided into desflurane group(group D)and seflurane group(group S).After induction of anesthesia,patients in group D were maintained with anesthesia with desflurane and remifentanil,and those in group S were maintained with sevoflurane and remifentanil.Record the basic Information of the two groups of patients during the perioperative period,follow up the patients before and after the operation,use the Mini-mental State Examination(MMSE)to evaluate and record the patients 1 day before and 1,2,3,4 days after surgery of cognitive function,and use the Confusion Assessment Method(CAM)to assess whether patients have POD;Chinese Richards Campbell Sleep Questionnaire(C-RCSQ)score was used to evaluate the sleep quality of patients 1 night before surgery,the night after surgery and 1 to 3 days after surgery;To compare the postoperative MMSE score,incidence of POD and C-RCSQ score of two groups of patients,as well as changes in heart rate(HR),mean arterial pressure(MAP),intraoperative blood loss and medication,Bispectral index(BIS)recovery to 90 after drug withdrawal,time to recovery of directional force and extubation,difference in incidence of nausea and vomiting(postoperative nausea and vomiting,PONV),choking,and agitation during recovery.Result: A total of 76 patients were included in the final test and analysis,and 38 patients in each group.There was no statistical difference between the two groups in gender,age,American Society of Anesthesiologists grade,Body mass index value,operation time,and intraoperative blood loss(P> 0.05).The incidence of pod in group D was 15.79%(6 cases),lower than 26.32% in group S(10 cases),but there was no significant difference between the two groups(P=0.26).The score of C-RCSQ of the first day after operation in group D was 53(49.55~55.05),which was higher than 42.9(40.75~46.85)in group S,and the difference was statistically significant(P<0.01).But there was no significant difference on the score of C-RCSQ between the two groups on the other three days(P >0.05).The MMSE score of group D was higher than that of group S on the first day(P <0.01),while there was no significant difference between the two groups on the next three days(P>0.05).In group D,HR and MAP fluctuated less at the beginning of surgery(P values were respectively<0.01),and the time from withdrawal to BIS recovery to 90,orientation recovery and extubation was shorter(P values were respectively<0.01).There was no significant difference in HR,MAP at the rest of time points and complications between the two groups(P > 0.05).Conclusions:Although there was no significant difference in the incidence of POD between desflurane and sevoflurane in elderly patients underwent radical laparoscopic colorectal /rectal cancer surgery,the patients in the desflurane group had better sleep quality and quick recovery of early cognitive function on the night after surgery.In addition,hemodynamic effects during operation are more stable,and recovery from surgery is faster.