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There is no significant difference between desflurane and propofol on the incidence of postoperative delirium, early cognitive outcomes, or wake up times among obese patients undergoing total knee replacement.
Postoperative delirium and cognitive decline are recognized
as one of the most frequent surgical complications in older patients. The aging
brain is more sensitive to develop delirium when exposed to anesthetic agents.
Therefore, it is necessary to study the effect of anesthesia on the incidence
of delirium and cognitive decline in elderly patients.
A randomized comparative trial was conducted among 100
obese patients to investigate the incidence of delirium and cognitive decline,
wake-up times and its regulation using different anesthesia. The patients
underwent total knee replacement under general anesthesia (Propofol or
Desflurane) with a femoral nerve block catheter. Patients were divided into two
groups, one received Propofol, and other received Desflurane.
The results were evaluated at two endpoints, primary and
secondary. The primary endpoint was delirium which was measured by the
Confusion Assessment Method (CAM). The secondary endpoint was a battery of six
different tests of cognitive function and wake-up times.
Out of 100 patients, 4 patients that provided informed
consent were withdrawn from the study. Now of the remaining 96 patients, 6 did
not complete the full CAM test. Further, Propofol group was known to have one
patient with delirium compared to zero in Desflurane group. One of the patients
in desflurane group also developed a confused state, but not characterized as
delirium. The duration of surgery and anesthesia, amount of intraoperative
fentanyl and preoperative pain scores were same in both the groups. Same as
these, there was no difference in the incidence of postoperative nausea,
vomiting and length of post-anesthesia care unit (PACU) between the groups.
Additionally, 50% of the patients showed a 20% decrease in results of at least
one cognitive test on the first two days after the surgery, and there was no
any difference among the groups.
This study demonstrated a low prevalence of delirium, but
the significant cognitive decline was noted in the first 48 h after surgery.
The study had a small sample size, and there was no difference in the
occurrence of postoperative delirium, early cognitive outcomes, or wake up
times between the Desflurane or Propofol group. Further studies with big sample
size are desired to guide clinical practice in choosing suitable anesthesia for
elderly patients undergoing surgery.
Journal of Clinical Anesthesia
The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial
Tanaka P et al.
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