May FY24

[A Schutter]

Cognitive function and delirium following sevoflurane or propofol anesthesia for valve replacement surgery: A multicenter randomized controlled trial.

The reason I selected this article is that several of my elderly patients have shared their concerns about experiencing temporary memory problems or confusion after undergoing general anesthesia. Some have even reported that these issues persisted for several months. While previous studies have identified inhaled anesthetics as a possible cause, recent research suggests that propofol may be more likely to cause cognitive problems after surgery than inhaled anesthetics.

Please answer the following two questions

1. How might this study's findings on cognitive function and delirium following valve replacement surgery under sevoflurane or propofol anesthesia extend to other surgical populations?

2. In what ways could the results of this research impact the choice of anesthesia for various surgical procedures beyond valve replacement surgery in terms of postoperative cognitive outcomes and delirium incidence?

[Sue Kim]

1. How might this study's findings on cognitive function and delirium following valve replacement surgery under sevoflurane or propofol anesthesia extend to other surgical populations?

This is an interesting finding with statistically significant results favoring the use of sevo versus TIVA in reducing POCD. The article did cite another large study comparing the same two types of anesthesia for patients undergoing major non-cardiac surgery and found the opposite results. So it is hard to say if this study alone should be used to extend to other surgical populations. For instance, the incidence of POD is significantly higher in the pediatric population when using sevo versus TIVA. In conclusion, I find it hard to change or apply this practice change solely based on this article.

2. In what ways could the results of this research impact the choice of anesthesia for various surgical procedures beyond valve replacement surgery in terms of postoperative cognitive outcomes and delirium incidence?

I think it is valid to consider the implications of this study in one's practice. But it also showed that there were no long term adverse effects (i.e. longer hospital stays, extended ICU stays, postoperative complications). I would like to know if perhaps 6 months to a year or so later, if there is a difference in cognitive function between the two groups studied.

[Amy Swank]

I wasn't totally clear of the difference between the two questions asked.
Although several preclinical studies have confirmed that both IA and propofol have neuroprotective effects against brain ischemia-reperfusion injury, the efects of different GAs in different patient populations and clinical settings are controversial per the article.
In CABGs, IA provides better brain protection than propofol-based TIVA.
By contrast, for major cancer surgery, propofol-based TIVA can decrease the incidence of postop cognitive dysfunction compared with IA.
Other studies have demonstrated that there was no significant difference betwen propofol and Sevo in postop cognitive outcomes following noncardiac surgery.
*Taking previous findings into consideration, it remains unclear which type of anesthesia is beneficial for reducing the risk of cognitive dysfuncion for heart valve replacement surgery.

[Tracey Trainum]

The results of the study are interesting, but as stated in the article further studies are needed to replicate and support the findings. Long term differences were not seen between groups. Furthermore, the sample sizes and types of patients studied vary compared to previous studies/findings. This article references one previous study that found propofol actually had better neuroprotective effects at the 1-week mark, with a study population age range of 65-90 years, whereas this study found sevoflurane with better protective effects in the immediate post op phase- but age studied was 18-65 years. Based on the results of this study I would not change my practice or attempt to extrapolate the data to other types of surgeries. The results are interesting but need further studies to support the findings.

[aileenm4]

1. I think the statement at the end says need further studies to really be amble to prove one way or another , but sounds like Sevo was protective in this study for valve surgery, there are extra considerations for valves and increase incidence of cerebral emboli and ischemia, bypass eyc.
2. interesting they talked about increase delirium and peds cases with Sevo, we find this true in peds and often switch to Iso as maintenance after induction or give other meds like Dexmededtomidine to help prevent delirium in high risk age groups. also interesting that Propofol was considered neuroprotective in some surgeries besides valve surgeries. I think further research and outcomes are needed and depends on cases by case for the type and plan of anesthesia to decrease the incidence of POD