The Effects of Propofol and Sevoflurane on Postoperative Delirium in Older Patients: A Randomized Clinical Trial Study

Article type: Research Article

Authors: Mei, Xinchun^{a; 1} | Zheng, Hai-Lin^{b; 1} | Li, Cheng^c | Ma, Xin^d | Zheng, Hui^e | Marcantonio, Edward^f | Xie, Zhongcong^{g; *} | Shen, Yuan^{h; *}

Affiliations: [a] Department of Psychiatry, Shanghai Tenth People’s Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, P. R. China | [b] Department of Psychiatry, Shanghai Tenth People’s Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, P. R. China | [c] Department of Anesthesiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, P. R. China | [d] Tongji University School of Medicine, Shanghai, P. R. China | [e] Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA | [f] Divisions of General Medicine and Primary Care and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA | [g] Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA | [h] Department of Psychiatry, Shanghai Tenth People’s Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, P. R. China

Correspondence: [*] Correspondence to: Yuan Shen, MD, PhD, Department of Psychiatry, Shanghai Tenth People’s Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, 301 Yanchang Road, Outpatient Clinic Building, Room 4405, Shanghai 200072, P. R. China. Tel./Fax: +86 21 66303649; E-mail: kmshy@tongji.edu.cn.; Zhongcong Xie, MD, PhD, Professor of Anesthesia, Geriatric Anesthesia Research Unit, Department of Anesthesia, Massachusetts General Hospital and Harvard Medical School; 149 13th Street, Room 4310; Charlestown, MA 02129-2060, USA. Tel.: +1 617 724 9308; Fax: +1 617 643 9277; E-mail: zxie@mgh.harvard.edu

Note: [1] These authors contributed equally to this work.

Abstract: Background:Postoperative delirium is associated with adverse postoperative outcomes. However, whether intravenous and inhalation anesthetics are associated with different risks of postoperative delirium remains unknown. Objective:We set up to determine the incidence and duration of postoperative delirium in older patients who had surgery under the intravenous anesthetic propofol or the inhalational anesthetic sevoflurane. Methods:Participants were patients who had total hip/knee replacements and were randomized to propofol (N = 106) or sevoflurane (N = 103) anesthesia group. The Confusion Assessment Method was employed by investigators who were blinded to the anesthesia regimen to assess the incidence and duration (days of postoperative delirium per person) of postoperative delirium on postoperative days 1, 2, and 3. Results:A total of 209 participants (71.2±6.7 years old, 29.2% male) were included in the final data analysis. The incidence of postoperative delirium was 33.0% with propofol anesthesia and 23.3% with sevoflurane anesthesia (p = 0.119, Chi-square test), and we estimated that we would need 316 participants in each arm to detect a potential statistically significant difference. Days of postoperative delirium per person were higher in the propofol (0.5±0.8) anesthesia group compared to the sevoflurane anesthesia group (0.3±0.5, p = 0.049, Student’s t-test). Conclusion:This pilot study established a system to compare effects of different anesthetics and generated a hypothesis that propofol trended to have a higher incidence and had longer duration of postoperative delirium than sevoflurane. Additional studies with a larger sample size are needed to test this hypothesis.

Keywords: Anesthesia, delirium, postoperative, propofol, sevoflurane

DOI: 10.3233/JAD-200322

Journal: Journal of Alzheimer's Disease, vol. 76, no. 4, pp. 1627-1636, 2020