Research Article: Effect of sevoflurane post-conditioning on postoperative cognitive function in carotid endarterectomy patients: a randomized, double-blind, controlled trial
Abstract:
This study evaluated the effect of low-dose sevoflurane post-conditioning on early neurocognitive recovery in patients aged 50–80?years undergoing carotid endarterectomy (CEA).
In this randomized, double-blind, single-center trial, 71 patients undergoing elective CEA receiving either sevoflurane post-conditioning (Group S, n =?36) or standard propofol-based anesthesia (Group P, n =?35) were analysed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline, and on postoperative days 1 and 3. The primary outcome was the change in cognitive scores from baseline.
The two-way repeated-measures ANOVA revealed a significant main effect of group for both MMSE ( p <?0.001) and MoCA ( p =?0.019) scores. As the groups were comparable at baseline, this difference emerged postoperatively, driven by divergent outcomes on day 1: the propofol group (Group P) experienced a significant change in cognitive scores from baseline in both MMSE (?0.97?±?1.81) and MoCA (?0.80?±?1.83), whereas the scores in the sevoflurane group (Group S) were preserved in both MMSE (+0.58?±?1.76) and MoCA (+0.81?±?2.59). A significant between-group difference was therefore evident on postoperative day 1 (MMSE p =?0.002; MoCA p =?0.037) and was maintained on postoperative day 3 (MMSE p =?0.023; MoCA p =?0.036).
Low-dose sevoflurane post-conditioning provides superior short-term preservation of cognitive function compared to standard anesthesia in patients undergoing CEA. These findings support the potential neuroprotective role of sevoflurane post-conditioning. Further research is warranted to explore long-term outcomes that incorporate biological sample testing.
https://ClinicalTrials.gov , NCT04950205.
Introduction:
Perioperative neurocognitive disorders (NCDs), such as delirium and postoperative cognitive dysfunction (POCD), are the predominant postoperative complications in older patients ( 1 ). The incidence of postoperative delirium ranges from 11 to 51%, depending on the type of procedure, while POCD incidence varies between 9.9 and 40% ( 2 , 3 ). Delayed neurocognitive recovery or POCD significantly impacts long-term outcomes, manifesting as early withdrawal from the workforce, increased reliance on social welfare, and…
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