Effects Of Etomidate On Inflammatory Cytokines And Early Postoperative Cognitive Dysfunction In The Elderly Patients

Objective: To evaluate the effect of Etomidate on inflammatorycytokines and early postoperative cognitive dysfunction after abdominalsurgery in elderly patients.Methods:40patients aged more than60years underwent electiveabdominal surgery, in accordance with the random number table, wererandomly divided into Treatment group (etomidate total intravenousanesthesia, Group E) and Control group(propofol total intravenousanesthesia，Group P),20cases in each group.5ml peripheral venous bloodwere respectively collected in times of before induction of anesthesia(T0)、ending of operation(T2)、2h(T3) and24h postoperatively(T4). TheInterleukin6(IL-6),interleukin10(IL-10) and tumor necrosis factorα(TNF-α) are measured by enzyme linked immunosorbent assay(ELISA).Mine-mental state examination (MMSE) method was tested to evaluate thecognitive function of patients before surgery24h and postoperative24h.Preoperative﹑intraoperative and postoperative hemodynamic parameters were recorded in two groups, as well as operating time、recovery time、blood loss、urine output、and fluid volume.Results: Compared with T0, the concentration of IL-6and IL-10inboth Groups were raised at T2、T3and T4(P＜0.01). The concentrationTNF-αat T2and T3in both Groups were higher than that at T0(P＜0.01),but there was no significant difference in the concentration TNF-αbetweenat T4and T0(P＞0.05). The concentration of IL-6and TNF-αin twoGroups at T3were lower than at T2, as were as at T4than at T3(P＜0.01).The concentration of IL-10in two groups at T3were higher than at T2(P＜0.05)，while that at T4were lower than at T3(P＜0.01). Between the twogroups, there was no significant difference in the concentration of L-6、IL-10and TNF-αat Toand T3, and the concentration of IL-6and TNF-αinGroup E at T2and T3were higher than that in Group P (P＜0.05)，but theconcentration of IL-10in Group E at T2and T3were lower than that inGroup P (P＜0.05). The scores of MMSE in Group P and E at24hpostoperatively were lower than that at24h preoperatively (P＜0.05). Theincidence of POCD in Group P was36.8%, and that in Group E was50%.There is no significant difference between two groups in the incidence ofPOCD(P＞0.05).Conclusions: The effect of the decrease of inflammatory cytokinesand the increase of anti-inflammatory cytokines by Etomidate intravenousanesthesia was lower than by Propofol intravenous anesthesia. This effect was temporary and there was no difference at24h postoperatively.Compared to Propofol, Etomidate can be used in intravenous anesthesiawithout increasing the incidence of POCD and it can be used as the firstchoice of general anesthesia medication for the elderly.