The Effects of Isoflurane and Desflurane on Cognitive Function in Humans

• Published in: Anesthesia and analgesia Vol. 114; no. 2; pp. 410 - 415
• Main Authors: Zhang, Bin, Tian, Ming, Zhen, Yu, Yue, Yun, Sherman, Janet, Zheng, Hui, Li, Shuren, Tanzi, Rudolph E., Marcantonio, Edward R., Xie, Zhongcong
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.02.2012; Lippincott Williams & Wilkins
• Subjects: Aged; Analysis of Variance; Anesthesia; Anesthesia, Spinal; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - administration & dosage; Anesthetics, Inhalation - adverse effects; Biological and medical sciences; Boston; China; Cognition - drug effects; Cognition Disorders - chemically induced; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Female; Humans; Isoflurane - administration & dosage; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Male; Medical sciences; Middle Aged; Neuropsychological Tests; Pilot Projects; Prospective Studies; Time Factors; Treatment Outcome; China; Boston; Volatile compound; Human; General anesthetic; Desflurane; Anesthesia; Isoflurane; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598; 1526-7598
• DOI: 10.1213/ANE.0b013e31823b2602

The etiology of postoperative cognitive decline (POCD) remains to be determined. Anesthetic isoflurane, but not desflurane, may induce neurotoxicity. However, the functional consequences of these effects have not been assessed. We therefore performed a pilot study to determine the effects of isoflurane and desflurane on cognitive function in humans. The subjects included patients who had lower extremity or abdominal surgery under spinal anesthesia alone (S, n = 15), spinal plus desflurane anesthesia (SD, n = 15), or spinal plus isoflurane anesthesia (SI, n = 15) by randomization. Each of the subjects received cognitive tests immediately before and 1 week after anesthesia and surgery administered by an investigator who was blinded to the anesthesia regimen. POCD was defined using the scores from each of these tests. We studied 45 subjects, 24 males and 21 females. The mean age of the subjects was 69.0 ± 1.9 years. There was no significant difference in age and other characteristics among the treatment arms. The mean number of cognitive function declines in the S, SD, and SI groups was 1.13, 1.07, and 1.40, respectively. POCD incidence after SI (27%), but not SD (0%), anesthesia was higher than that after S (0%), P = 0.028 (3-way comparison). These findings from our pilot study suggest that isoflurane and desflurane may have different effects on postoperative cognitive function, and additional studies with a larger sample size and longer times of follow-up testing are needed.