Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance

医学 异丙酚 异氟醚 麻醉 围手术期 前瞻性队列研究 脑脊液 阿尔茨海默病 神经认知 外科 内科学 认知 疾病 精神科
作者
Daniel Villalobos,Melody Reese,Mary Cooter,Megan K. Wong,Ayesha Syed,John Park,Ashley Hall,Jeffrey N. Browndyke,Katherine T. Martucci,Michael J. Devinney,Leah Acker,Eugene W. Moretti,Leonard Talbot,Brian Colin,Brian Ohlendorf,Teresa Waligórska,Yi‐Ju Li,Heather E. Whitson,Harvey Jay Cohen,Joseph P. Mathew,Miles Berger
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier BV]
卷期号:131 (2): 328-337 被引量:4
标识
DOI:10.1016/j.bja.2023.04.019
摘要

Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans.This was a nested randomised controlled trial within a prospective cohort study; patients age ≥60 yr undergoing noncardiac/non-neurological surgery were randomised to isoflurane or propofol for anaesthetic maintenance. Cerebrospinal fluid (CSF) was collected via lumbar puncture before, 24 h, and 6 weeks after surgery. Cognitive testing was performed before and 6 weeks after surgery. Nonparametric methods and linear regression were used to evaluate CSF biomarkers and cognitive function, respectively.There were 107 subjects (54 randomised to isoflurane and 53 to propofol) who completed the 6-week follow-up and were included in the analysis. There was no significant effect of anaesthetic treatment group, time, or group-by-time interaction for CSF amyloid-beta (Aβ), tau, or phospho-tau181p levels, or on the tau/Aβ or p-tau181p/Aβ ratios (all P>0.05 after Bonferroni correction). In multivariable-adjusted intention-to-treat analyses, there were no significant differences between the isoflurane and propofol groups in 6-week postoperative change in overall cognition (mean difference [95% confidence interval]: 0.01 [-0.12 to 0.13]; P=0.89) or individual cognitive domains (P>0.05 for each). Results remained consistent across as-treated and per-protocol analyses.Intraoperative anaesthetic maintenance with isoflurane vs propofol had no significant effect on postoperative cognition or CSF Alzheimer's disease-related biomarkers within 6 weeks after noncardiac, non-neurological surgery in older adults.NCT01993836.
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