The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery

• Published in: Anaesthesia Vol. 66; no. 6; pp. 455 - 464
• Main Authors: Royse, C. F., Andrews, D. T., Newman, S. N., Stygall, J., Williams, Z., Pang, J., Royse, A. G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2011; Wiley-Blackwell
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - pharmacology; Anesthetics, Intravenous - pharmacology; Biological and medical sciences; Clinical trials; Cognition & reasoning; Cognition - drug effects; Cognition Disorders - etiology; Coronary Artery Bypass - adverse effects; Female; Follow-Up Studies; Heart surgery; Humans; Isoflurane - analogs & derivatives; Isoflurane - pharmacology; Male; Medical sciences; Middle Aged; Neuropsychological Tests; Postoperative period; Propofol - pharmacology; Risk Factors; Volatile compound; Human; Postoperative; Cognitive disorder; General anesthetic; Desflurane; Surgery; Cardiovascular disease; Anesthesia; Propofol; Coronary heart disease; Halogen Organic compounds
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2011.06704.x

Summary We investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ≥ 1 SD deterioration in two or more of 12 neurocognitive tests. Secondary outcomes included early postoperative cognitive dysfunction (between days three and seven), delirium on day one, morbidity and length of hospital stay. Early postoperative cognitive dysfunction was significantly higher with propofol compared with desflurane (56/84 (67.5%) vs 41/83 (49.4%), respectively, p = 0.018), but this effect was not seen at 3 months (10/87 (11.2%) vs 9/90 (10.0%), respectively. There was no difference in delirium (7/89 (7.9%) vs 12/91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6‐9 [4‐15]) vs 6 (5‐7 [5‐16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction.