Impact Of Isoflurane Anesthesia On Postoperative Cognitive Function Of Female Patients Who Undergoing Cardiopulmonary Bypass Surgery

Objectives To investigate the effects of isoflurane inhaled anesthesia on postoperative cognitive dysfunction of female patients who undergoing CPB(cardiopulmonary bypass)cardiac surgery and the relationship between CRP and postoperative cognitive function.Method 59 female patients scheduled for CPB surgery aging 35 to 60,in state of ASAⅡ～Ⅲwere randomly divided into two groups with 22 in group I(isoflurane group)and 37 in group P(propofol group). Excluded standard:no serious hepatic and renal dysfunction and active inflammation.The two groups were induced by same method:fentanyl 5～10μg/kg,Midazolam 0.08～0.12mg/kg,vecuronium 0.1mg/kg,then had mechanical ventilation after tracheal intubation.Anesthesia was maintained by inhalation of isoflurane between 1.5 and 2 combined with intermittent injection of fentanyl,Midazolam and vecuronium in group I.Group P was maintained by propofol 4～6mg/kg/h Continuous infusion with intermittent injection of fentanyl,Midazolam and vecuronium.Blood samples were taken from peripheral vein before induction,24 hours postoperative and 6 days after surgery.The neuropsychology assessment was measured by MMSE(mini-mental state exam)the first day preoperative,7 day,and 1 month postoperative by WAIS-RC(Wechsler Adult Intelligence Scale RC 2+1)which including information,comprehension,digit span,picture completion,picture arrangement.Result 6 patients showed cognitive dysfunction in group I and 11 in group P 7 day postoperative,The rate of POCD(postoperative cognitive dysfunction)in group I was 27.3%and 29.7%in group P.one month later after surgery,3 patients still remained cognitive dysfunction in group I and ??4 in group P.The rate of POCD in group I was 13.5%and 10.8%in group P,but there was no statistic significance between the two groups. (P＞0.05)2.The Pearson's correlation between CRP preoperative with 7 day,1 month postoperative WAIS-RC score was -0.55 and -0.63.The Pearson's correlation between CRP 6 days postoperative with 7 day,1 month postoperative WAIS-RC score was-0.61,-0.66.(P＜0.05)The Pearson's correlation between CRP 24 hours post- operative with 7 day,1 month postoperative WAIS-RC score has no statistics significance. (P＞0.05)Conclusion 1.Group I showed no improvement in cognitive outcomes postoperative compared with group P after CPB surgery. 2.Patients with the level of CRP increased preoperative and 6 day postoperative suggested cognitive decline after CPB surgery.