Influence Of Cognition Function In Gerontal Patients After Operation Under Remifentanil And Fentanyl Target Control Infusion

Objective:To compare postoperative cognitive function in gerontal patients after operation under Remifentanil and fentanyl Target Control Infusion Total Intravenous Anesthesia.Methods:Forty ASAâ… -â…¡gerontal patients (23male and 17female) aged 60-70years undergoing laparoscopic operation were randomized two groups to receive target-controlled infusion with remifentanil and propofol (RF group) or fentanyl and propofol (F group). Cognitive function was assessed by the Wechsler Intelligence Scale for Adut (WAIS) at four time points:at 1 day before (T1,at base line) and at 1days(T2),3days(T3),5days(T4) after surgery for all patients. Postoperative cognitive dysfunction was defined by the 1 standard deviation (1SDS) and Z-score analysis. Results:(1) In the same deep of anesthesia [(bispectral index, BIS) was 40-60], there were significant difference in WAIS score between the two groups before and after surgery (P<0.01)The WAIS scores decreased significantly at 1 day after operation compared with 1 day before operation in both groups, and returned to preoperative baseline levels within 3-5 day after surgery. The percentage of the patients who developed postoperative cognitive dysfunction (POCD) was 70% at 1 day after operation and 20% at 3 day after operation in RF group. In F group the percentage of patients who developed POCD was 80% at 1 day after operation and 20% at 3 day after operation. (2) Steward score and Prince-Henry score were significant difference between two groups (P<0.01) Eye opening and Extubation and time in OR after end Of surgery were no significantly shorter in the RF group than that in the F group (P>0.05). Be subjected to level of education was significant difference between two groups (P<0.01). the amounts of atropine,ephedrine and urapidil administered during operation were no significant difference between two groups (P>0.05).Conclusion: Target controlled infusion anesthesia with remifentanil and fentanil may induce temporarily postoperative cognitive dysfunction.