Optimized Anesthesia to Alleviate Postoperative Cognition Decline in Female Middle-Aged Patients Undergoing Laparoscopic Myomectomy: A Pilot StudyAuthor(s): Jianhui Liu, Li Cai, Junjun Yang, Gang Guo, Heng Wu, Yanhong Zhao, Xiaoqing Zhang
The purpose of this randomized, single-center study was to clarify the impact of anesthetic regimens for laparoscopic myomectomy on the release of cytokines (interleukin IL-1β, IL-2R IL-6, IL-8, tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP) and to ascertain that whether a combination of intravenous and inhalational anesthesia compared with inhalational anesthesia attenuates the inflammatory response and cognitive impairment.
We enrolled 90 patients undergoing laparoscopic myomectomy (LM), and allocated them into three groups of 30 to receive high concentration sevoflurane (S group), low concentration sevoflurane with dexmedetomidine (SD) or with propofol (SP) in combine with remifentanil and cis-atracurium. The lungs were maintained normocapnia with mechanically ventilated. If the mean arterial pressure and the heart rate increased by >30% from baseline, remifentanil infusion was adjusted. The depth of anesthesia was modulated to maintain a bispectral index (BIS) of 40-60. Invasive hemodynamic monitoring was used. Serum levels of IL-1β, IL-2R, IL-6 and IL-8, TNF-α, and CRP were measured before anesthesia and 24 h post operation. The neurocognitive tests were administered 1 day before and 7 days post operation. Postoperative complications (including pain, infection, sedation, cardiovascular and neurological events) were surveillance during the first week post operation.
Patients anesthetized with low concentration sevoflurane plus dexmedetomidine had lower levels of IL-6 (p=0.0001) and better cognitive function compared with patients with high concentration sevoflurane postoperatively. There was no POCD occurrence among all the three groups in the 7days follow-up.
LM female middle-aged patients exposured to low concentration sevoflurane plus dexmedetomidine had better cognitive function than patients with high concentration sevoflurane, which might be related to lower release of IL-6 post operation.