Abstract
This study was aimed to systematically evaluate the effects of fentanyl and sufentanil on intraoperative cerebral oxygen saturation changes and postoperative cognitive function in elderly patients undergoing open surgery. Ninety-six elderly patients who had undergone open surgery under general anesthesia were randomly divided into fentanyl group (F group, anesthesia by fentanyl, 4 g/kg) and sufentanil group (S group, anesthesia by sufentanil, 0.4 µg/kg). There were no significant differences between the F group and S group in the general characteristics of patients. Compared to the F group, the S group had a better effect on suppressing the stress response, maintaining a stable hemodynamic status and achieving better anesthesia effects. The anesthesia recovery time of the S group was significantly shorter than that of the F group. There was no significant difference between the two groups in the intraoperative and postoperative agitation. Patient’s waking time and extubation time were significantly shorter in the S group than the F group. The VAS scores in the S group were significantly lower than those in the F group at each time point. The Ramsay scores in the S group were significantly higher than those in the F group at each time point. The cerebral oxygen saturation (SctO2) levels in both groups were significantly increased following anesthesia induction and intubation compared to that of the awake state (P < 0.05), and SctO2 was significantly decreased during the surgery in both groups. The changes in SctO2 levels were not significantly different between the two groups (P > 0.05). The SctO2 level was significantly higher during surgery than that after intubation. Compared with the F group, the relative value of SctO2 decline in the S group was smaller. Compared to the day before surgery, the Montreal Cognitive Assessment (MoCA) scores of both groups were significantly reduced after surgery. At 1 day post-surgery, the MoCA scores of the S group were significantly higher and the incidence of postoperative cognitive dysfunction (POCD) was significantly lower compared to the F group. POCD occurred in three patients (6.2%) in the S group, and the ratio was significantly lower than that in the F group (11.9%) (P < 0.05). It showed a consistent trend with the SctO2 status during the surgery. The relative value of SctO2 decline in the S group was significantly smaller than that in the F group. The reduction of cognitive function in the S group was significantly lower than that in the F group. These results indicate that the changes in SctO2 are a good prediction of the incidence of POCD.
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References
Sun W, Aodeng S, Tanimoto Y et al (2015) Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China. Arch Gerontol Geriatr 60:311–316. https://doi.org/10.1016/j.archger.2014.12.002
De Luca d’Alessandro E, Bonacci S, Giraldi G (2011) Aging populations: the health and quality of life of the elderly. Clin Ter 162:e13–e18
Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928. https://doi.org/10.1016/S0140-6736(03)14966-5
Steinmetz J, Christensen KB, Lund T et al (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110:548–555. https://doi.org/10.1097/ALN.0b013e318195b569
Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 351:857–861
Tang L, Kazan R, Taddei R et al (2012) Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth 108:623–629. https://doi.org/10.1093/bja/aer501
Chan MJ, Chung T, Glassford NJ et al (2017) Near-infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 31:1155–1165. https://doi.org/10.1053/j.jvca.2017.02.187
Lin R, Zhang F, Xue Q et al (2013) Accuracy of regional cerebral oxygen saturation in predicting postoperative cognitive dysfunction after total hip arthroplasty: regional cerebral oxygen saturation predicts POCD. J Arthroplasty 28:494–497. https://doi.org/10.1016/j.arth.2012.06.041
Clotz MA, Nahata MC (1991) Clinical uses of fentanyl, sufentanil, and alfentanil. Clin Pharm 10:581–593
Pouraghaei M, Moharamzadeh P, Soleimanpour H et al (2014) Comparison between the effects of alfentanil, fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department. Anesth Pain Med 4:e14618. https://doi.org/10.5812/aapm.14618
Salazar F, Donate M, Boget T et al (2011) Intraoperative warming and post-operative cognitive dysfunction after total knee replacement. Acta Anaesthesiol Scand 55:216–222. https://doi.org/10.1111/j.1399-6576.2010.02362.x
Hemmerling TM, Bluteau MC, Kazan R et al (2008) Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth 101:870–875. https://doi.org/10.1093/bja/aen275
Dalrymple-Alford JC, MacAskill MR, Nakas CT et al (2010) The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 75:1717–1725. https://doi.org/10.1212/WNL.0b013e3181fc29c9
Nasreddine ZS, Phillips NA, Bedirian V et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
Newman SP (1995) Analysis and interpretation of neuropsychologic tests in cardiac surgery. Ann Thorac Surg 59:1351–1355
Akan M, Oztekin S (2012) Endotracheal intubation without neuromuscular blocking agents: is it a good and safe option? Anesth Pain Med 1:267–268. https://doi.org/10.5812/aapm.3805
Farzi F, Mirmansouri A, Naderi Nabi B et al (2017) Comparing the effect of adding fentanyl, sufentanil, and placebo with intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing cesarean section. Anesth Pain Med 7:e12738. https://doi.org/10.5812/aapm.12738
Ayrian E, Kaye AD, Varner CL et al (2015) Effects of anesthetic management on early postoperative recovery, hemodynamics and pain after supratentorial craniotomy. J Clin Med Res 7:731–741. https://doi.org/10.14740/jocmr2256w
Leslie K, Troedel S, Irwin K et al (2003) Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology 99:1158–1165
Royse CF, Newman S, Chung F et al (2010) Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale. Anesthesiology 113:892–905. https://doi.org/10.1097/ALN.0b013e3181d960a9
Modak SD, Kane DG (2017) Conscious sedation for balloon mitral valvotomy: a comparison of fentanyl versus sufentanil. Ann Card Anaesth 20:163–168. https://doi.org/10.4103/0971-9784.203930
Kim J, Shim JK, Song JW et al (2016) Postoperative cognitive dysfunction and the change of regional cerebral oxygen saturation in elderly patients undergoing spinal surgery. Anesth Analg 123:436–444. https://doi.org/10.1213/ANE.0000000000001352
Ni C, Xu T, Li N et al (2015) Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction. BMC Anesthesiol 15:156. https://doi.org/10.1186/s12871-015-0117-6
Brodt J, Vladinov G, Castillo-Pedraza C et al (2016) Changes in cerebral oxygen saturation during transcatheter aortic valve replacement. J Clin Monit Comput 30:649–653. https://doi.org/10.1007/s10877-015-9758-8
Terrando N, Brzezinski M, Degos V et al (2011) Perioperative cognitive decline in the aging population. Mayo Clin Proc 86:885–893. https://doi.org/10.4065/mcp.2011.0332
Shi HJ, Xue XH, Wang YL et al (2015) Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients. Int J Clin Exp Med 8:3883–3888
Egawa J, Inoue S, Nishiwada T et al (2016) Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial. Can J Anaesth 63:1161–1169. https://doi.org/10.1007/s12630-016-0700-4
De Cosmo G, Sessa F, Fiorini F et al (2016) Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery. J Clin Anesth 35:40–46. https://doi.org/10.1016/j.jclinane.2016.07.016
Rasmussen LA, Ryhammer PK, Greisen J et al (2016) Ultrashort acting remifentanil is not superior to long-acting sufentanil in preserving cognitive function—a randomized study. J Clin Anesth 33:127–134. https://doi.org/10.1016/j.jclinane.2016.03.023
Bilotta F, Caramia R, Paoloni FP et al (2007) Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol 24:122–127. https://doi.org/10.1017/S0265021506001244
Martorano PP, Aloj F, Baietta S et al (2008) Sufentanil-propofol vs remifentanil-propofol during total intravenous anesthesia for neurosurgery. A multicentre study. Minerva Anestesiol 74:233–243
Kofke WA, Garman RH, Janosky J et al (1996) Opioid neurotoxicity: neuropathologic effects in rats of different fentanyl congeners and the effects of hexamethonium-induced normotension. Anesth Analg 83:141–146
Silbert BS, Scott DA, Evered LA et al (2006) A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly. Anesthesiology 104:1137–1145
Davis MP, Mehta Z (2016) Opioids and chronic pain: where is the balance? Curr Oncol Rep 18:71. https://doi.org/10.1007/s11912-016-0558-1
Brown RT, Zuelsdorff M, Fleming M (2006) Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain. J Opioid Manag 2:137–146
Scott JC, Cooke JE, Stanski DR (1991) Electroencephalographic quantitation of opioid effect: comparative pharmacodynamics of fentanyl and sufentanil. Anesthesiology 74:34–42
Rundshagen I (2014) Postoperative cognitive dysfunction. Dtsch Arztebl Int 111:119–125. https://doi.org/10.3238/arztebl.2014.0119
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Jun Zhang, Liang Chen, Yunyun Sun and Wensheng He have no conflict of interest to declare.
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Zhang, J., Chen, L., Sun, Y. et al. Comparative effects of fentanyl versus sufentanil on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing open surgery. Aging Clin Exp Res 31, 1791–1800 (2019). https://doi.org/10.1007/s40520-019-01123-8
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DOI: https://doi.org/10.1007/s40520-019-01123-8