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Zhou Y, Li Z, Ma Y, Yu C, Chen Y, Ding J, Yu J, Zhou R, Wang X, Liu T, Guo X, Fan T, Shi C. The Effect of Propofol versus Sevoflurane on Postoperative Delirium in Parkinson's Disease Patients Undergoing Deep Brain Stimulation Surgery: An Observational Study. Brain Sci 2022; 12:689. [PMID: 35741575 PMCID: PMC9221052 DOI: 10.3390/brainsci12060689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The selection of the maintenance of general anesthesia may affect the development of postoperative delirium (POD), notably for Parkinson's disease (PD) patients, due to their lower cognitive reserve. The present study was designed to compare the potential impact of propofol vs. sevoflurane based general anesthesia maintenance methods on the development of POD in PD patients following deep brain stimulation (DBS) surgery. METHODS A total of 125 PD patients who were scheduled to undergo DBS surgery were randomly divided into the propofol (n = 63) and the sevoflurane groups (n = 62). The patients in the two groups randomly received propofol- or sevoflurane-based general anesthesia. The Confusion Assessment Method (CAM) was employed by an investigator who was blinded to the anesthesia regimen and was administered twice per day from postoperative day 1 until discharge. RESULTS The incidence of POD was 22.22% (14/63) with propofol anesthesia and 20.97% (13/62) with sevoflurane anesthesia (p = 0.865). In addition, no difference was noted in the duration and severity of delirium between the propofol and sevoflurane groups. CONCLUSIONS In the present study, propofol- and sevoflurane-based general anesthesia exhibited comparable results with regard to the POD incidence in PD patients undergoing deep brain stimulation surgery.
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Affiliation(s)
- Yongde Zhou
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China; (Z.L.); (T.L.); (X.G.)
- Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Beijing,100191, China
| | - Yu Ma
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.M.); (R.Z.)
| | - Cuiping Yu
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Yao Chen
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Jian Ding
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Jianfeng Yu
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Rongsong Zhou
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.M.); (R.Z.)
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China;
| | - Taotao Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China; (Z.L.); (T.L.); (X.G.)
- Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Beijing,100191, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China; (Z.L.); (T.L.); (X.G.)
- Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Beijing,100191, China
| | - Ting Fan
- Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing 100040, China; (Y.Z.); (C.Y.); (Y.C.); (J.D.); (J.Y.)
| | - Chengmei Shi
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China; (Z.L.); (T.L.); (X.G.)
- Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Beijing,100191, China
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Makkad B, Heinke TL, Kertai MD. Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist? Curr Opin Anaesthesiol 2022; 35:18-35. [PMID: 34873076 DOI: 10.1097/aco.0000000000001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. RECENT FINDINGS Recent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery. SUMMARY Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.
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Affiliation(s)
- Benu Makkad
- Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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