The Effects Of Desflurane And Sevoflurane On Postoperative Cognitive Dysfunction In Aged Patients

Desflurane is a new type of inhalation anesthetics, The blood/gas distribution coefficient is lower than inhalable anesthetics. Induction and recovery are more quickly. In the process of anesthesia, Anesthesia depth can be controlled more easily.Postoperative cognitive dysfunction (POCD), is an early after surgery in patients with central nervous system diseases, it is founded in various major surgery or emergency surgery. The incidence of postoperative cognitive dysfunction of the elderly is much higher than other age groups. It is characterized by abnormal memory impairment or loss of cognitive function, personality and social integration ability changes and so on, Severe cases can appear dementia. They are related to extracorporeal circulation, large trauma caused by surgery, and the many reasons about the anoxia, or itself with the elderly physiological conditions and the influence of anesthesia on elderly patients with hemodynamic is larger. Also, using different anesthetic during surgery, the incidence of postoperative cognitive dysfunction is also different. This study compares the desflurane to maintain anesthesia with sevoflurane influence on cognitive function after surgery for elderly patients recover, then on this basis, we can look for ways to better maintain anesthesia in patients with elderly.Abjective:To compare the desflurane and sevoflurane effects on cognitive function after surgery for elderly patients.Method:Choose the American society of anesthesiologists (ASA) Ⅱ-Ⅲ level, Eighty patients aging60-85years undergoing abdominal surgical operation were randomized into two groups,weight45-75kg, Body mass index(BMI) is normal, Without history of high blood pressure, liver and kidney. No nervous system disease and family history of mental illness, no serious visual impairment and hearing disorders, no history of digestive tract ulcer and asthma. Randomly divided into2groups,40cases in each group, A group (desflurane), B group(sevoflurane). Anesthesia induction in the same way:Patients come to the operating room and are opened peripheral venous access, preoperative medicine is penehyclidine0.5mg (ten minues before anesthesia induction by titrator), Midazolam0.03mg/kg、 Sufentanil5ug/kg, propofol0.1mg/kg, Etomidate0.2mg/kg、 Cis-atracurium0.5mg/kg, Excessive ventilation3minutes later, make the concentration of the muscle relaxant peak for endotracheal intubation then mechanical ventilation, tidal volume8～10ml/kg,O2:N2O=2:3(2ml O2:3ml N2O or O2:1.5ml N2O), then open the inhalation anesthetics, make the MAC1.3for maintaining anesthesia depth. At the start of the operation, another5ug sufentanil for patients to maintain anesthetic analgesic, fifteen minutes later, another0.3mg Remo to prevent nausea and vomiting, multifunctional monitor is used to continuing Monitor non-invasive blood pressure(NIBP), Heart rate(HR),ECG, blood oxygen saturation. The cognitive function was assessed before induction(pm—operation)and at1,6,12,24and48h after operation, Mini—Mental State(MMS)test was used to compare the incidence of cognitive dysfunction among the two groups.Results:The MMS in group A and Group B at1and6h after operation was lower than that of pre-operation, but there was no difference after24h of post-operation. The MMS in group A at1and6h after operation was lower than that of pre-operation, but after12h of post-operation. The MMS in group B at1,6and12h after operation was lower than that of pre-operation, but there was no difference after24h of post-operation.Conclusion:Only from the post-operative recovery of cognitive function into consideration, desflurane is smaller than sevoflurane on the influence of recovery of cognitive function..