Association Of Different General Anesthesia Methods With Delayed Neurocognitive Recovery:Potential Moderating Effect Of Sleep Disturbance

BACKGROUND:The development of delayed neurocognitive recovery in elderly patients can lead to poor outcomes as well as prognosis.Sevoflurane and propofol are both commonly used clinical anesthetics,and there are differing conclusions regarding the effects of both on postoperative cognitive outcomes.In recent years,perioperative sleep disorders have received widespread interest,and it has been suggested that sleep abnormalities and circadian rhythm disturbances may be involved in anesthetic-induced postoperative cognitive decline,in addition,there is much evidence that altered sleep patterns are associated with poorer cognitive performance.Our study attempted to compare the effects of propofol versus sevoflurane anesthesia on cognitive outcome in elderly patients undergoing abdominal laparoscopic surgery at 1 week postoperatively,as well as to investigate whether changes in sleep quality perioperatively play a moderating effect during the effects of different anesthetics on delayed neurocognitive recovery.METHODS:This study was a single-center,randomized,observational trial.Subjects were elderly patients aged>60 years who were to undergo elective abdominal laparoscopic surgery and were randomized to receive propofol or sevoflurane anesthesia.Patients’subjective sleep was assessed using the Athens Insomnia Scale(AIS)on preoperative and postoperative days 1,3,and 7,and their cognitive function was assessed using neuropsychological test battery on preoperative and 1 week postoperatively.The primary outcome was the extent of change in cognitive performance in the propofol versus sevoflurane group at 1 week postoperatively,and the secondary outcome was the change in perioperative subjective sleep measures in both groups.Moderating effect models were established to analyze the moderating effect of perioperative sleep changes.RESULTS:A total of 90 patients were enrolled in the study,of which 33 patients in the propofol group and 32 patients in the sevoflurane group completed all subjective sleep measures and cognitive follow-up,with the total of 65 patients entering the final analysis.The Reliable Change Index(RCI)and Z-score were used to calculate the change in scores for each cognitive test,and the change in global cognitive performance was expressed as the global Z-score.Overall postoperative cognitive performance was worse in the sevoflurane group compared to the propofol group(Mean±SD:-0.22±0.50 vs.-0.54±0.52,p=0.01).There was no significant difference in the change in perioperative AIS scores between the two groups(F=0.08,p=0.78),and both groups had significantly higher postoperative AIS scores than preoperatively(F=17.41,p<0.001),with worsening of subjective sleep developing.Sleep quality preoperatively(R2=0.11,ΔR2=0.06,ΔF=4.45,p=0.04)and at postoperative day 7(R2=0.12,ΔR2=0.06,ΔF=4.64,p=0.04)had a significant moderating effect on propofol or sevoflurane in impacting postoperative cognitive decline.CONCLUSION:Sevoflurane-based general anesthesia may exacerbate the decline in cognitive performance in older adults 1 week after abdominal laparoscopic procedures compared with propofol-based general anesthesia,during which subjective sleep conditions on preoperative and postoperative day 7 have moderating effects.