Effects Of Different Anesthesia Methods On Perioperative Neurocognitive Disorders In Elderly Patients Undergoing Radical Resection Of Rectal Cancer

Objective To compare the effects of propofol-based total intravenous anesthesia(TIVA)and sevoflurane-based inhalational anesthesia(IA)on perioperative neurocognitive disorders(PND)in elderly patients undergoing radical resection of rectal cancer.Methods A total of 112 elderly patients with rectal cancer undergoing elective laparoscopic radical resection under general anesthesia in the hospital were enrolled between October 2020 and October 2021.According to random number table method,they divided into TIVA group(n=56)and IA group(n=56).Both group were given tracheal intubation for general anesthesia,and TIVA group and IA group were given propofol and sevoflurane to maintain anesthesia during surgery,respectively.The perioperative clinical data of patients were collected,including preoperative general data,operation time,anesthesia time,average BIS,intraoperative blood loss,intraoperative blood transfusion rate and hospitalization time.The mean arterial pressure(MAP)and heart rate(HR)before anesthesia induction(t0),at 5min after intubation(t1),5min after skin incision(t2),after 1h of surgery(t3),2h of surgery(t4),after surgery(t5)and at 5min after extubation(t6),intraoperative and postoperative adverse reactions,and scores of Visual Analogue Scale(VAS)at 6h,12 h,24h and 48 h after surgery were recorded.At 1d before surgery and 3d,7d,1 month and 12 months after surgery,scores of mini-mental state examination(MMSE)were evaluated.Before anesthesia,at 1d,3d and 7d after surgery,levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-1β(IL-1β)were detected.Results1.General data: Among the 112 surgery patients,there were 11 cases withdrawing due to changes of treatment methods,severe complications or death and loss of follow-up,with samples loss rate of 9.82%(11/112).There were 101 patients completing the whole study,including 50 cases in IA group and 51 cases in TIVA group.There was no significant difference in general data [age,gender,BMI,years of education,grading of American society of anesthesiologists(ASA),preoperative MMSE score] between the two groups(P>0.05).2.Haemodynamics indexes: At t0,t1,t2,t3,t4,t5 and t6,there was no significant difference in MAP or HR between the two groups(P>0.05).3.Perioperative indexes: There was no significant difference in operation time,anesthesia time,average BIS,intraoperative blood loss,intraoperative blood transfusion rate or hospitalization time between the two groups(P>0.05).4.Adverse reactions: There was no significant difference in incidence of adverse reactions(intraoperative hypertension,hypotension,arrhythmia,emergence agitation,nausea,vomiting)between the two groups(P>0.05).5.Pain degree: At 6h,12 h,24h and 48 h after surgery,there was no significant difference in VAS scores between the two groups(P>0.05).6.Scores of cognitive function: After surgery,MMSE scores were firstly decreased and then increased in both groups.At 3d and 7d after surgery,MMSE scores were significantly lower than those at 1d before surgery in both groups(P<0.05).At 1month and 12 months after surgery,there was no significant difference in MMSE scores between the two groups(P>0.05).7.Occurrence of PND: At 3d and 7d after surgery,incidence of PDN in TIVA group was significantly lower than that in IA group(P<0.05),but there was no significant difference between the two groups at 1 month and 12 months after surgery(P>0.05).8.Inflammatory cytokines: At t0,there was no significant difference in levels of IL-6,TNF-α and IL-1β between the two groups(P>0.05).After surgery,levels of IL-6,TNF-α and IL-1β in both groups were firstly increased and then decreased(P<0.05).At 1d,3d and 7d after surgery,levels of IL-6,TNF-α and IL-1β in TIVA group were significantly lower than those in IA group(P<0.05).Conclusions1.Both propofol-based TIVA and sevoflurane-based IA can cause cognitive decline in elderly patients after radical resection of rectal cancer.2.Compared with sevoflurane-based IA,propofol-based TIVA can reduce the incidence of postoperative short-term PND.3.Compared with sevoflurane-based IA,propofol-based TIVA can inhibit inflammatory response.