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. 2024 Jul 9:16:1410181.
doi: 10.3389/fnagi.2024.1410181. eCollection 2024.

Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study

Huiting Zhuge #  1 , Yu Zhou #  2 , Yimin Qiu  2 , Xiaojing Huang  2
Affiliations

Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study

Huiting Zhuge et al. Front Aging Neurosci. .

Abstract

Background: Cognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients.

Methods: Sixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA <26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55-65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed.

Results: BIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, p = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, p = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups.

Conclusion: Compared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly.

Keywords: Montreal Cognitive Assessment; bispectral index; cognition; elderly; propofol.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of participants.
Figure 2
Figure 2
Comparison of bispectral index (BIS) at different time points. *p < 0.05 vs. cognitively normal (CogN) group. T0: before induction of anesthesia; T1: abolished eyelash reflex, T2: induction to a BIS index of 50; T3; after intubation.
Figure 3
Figure 3
Comparison of propofol requirement at bispectral index (BIS) value of 50. *p < 0.05 vs. cognitively normal (CogN) group.
Figure 4
Figure 4
Preoperative and postoperative Montreal Cognitive Assessment (MoCA) scores, pre-op, pre-operation; POD, postoperative day.
Figure 5
Figure 5
Postoperative Visual Analogue Scale (VAS) scores. POD, postoperative day.
See this image and copyright information in PMC

References

    1. Abbott T. E. F., Pearse R. M. (2019). Depth of Anesthesia and postoperative delirium. JAMA 321, 459–460. doi: 10.1001/jama.2019.0164 - DOI - PubMed
    1. Berger M., Nadler J. W., Browndyke J., Terrando N., Ponnusamy V., Cohen H. J., et al. . (2015). Postoperative cognitive dysfunction: minding the gaps in our knowledge of a common postoperative complication in the elderly. Anesthesiol. Clin. 33, 517–550. doi: 10.1016/j.anclin.2015.05.008, PMID: - DOI - PMC - PubMed
    1. Bokeriia L. A., Golukhova E. Z., Breskina N. Y., Polunina A. G., Davydov D. M., Begachev A. V., et al. . (2006). Asymmetric cerebral embolic load and postoperative cognitive dysfunction in cardiac surgery. Cerebrovasc. Dis. 23, 50–56. doi: 10.1159/000095759, PMID: - DOI - PubMed
    1. Caza N., Taha R., Qi Y., Blaise G. (2008). The effects of surgery and anesthesia on memory and cognition. Prog. Brain Res. 169, 409–422. doi: 10.1016/S0079-6123(07)00026-X - DOI - PubMed
    1. Chan M. T., Cheng B. C., Lee T. M., Gin T., CODA Trial Group (2013). BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J. Neurosurg. Anesthesiol. 25, 33–42. doi: 10.1097/ANA.0b013e3182712fba - DOI - PubMed

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