Effects of Different Injection Rates of Propofol on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Inguinal Hernia Repair

Tingting Li; Wenjing Han; Xinlu Yang; Yu Wang; Li Peng; Lingwei He; Lianjia Hu; Jiayuan Liu; Min Xia; Sheng Wang

doi:10.2147/DDDT.S407905

Effects of Different Injection Rates of Propofol on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Inguinal Hernia Repair

Drug Des Devel Ther. 2023 Jun 13:17:1741-1752. doi: 10.2147/DDDT.S407905. eCollection 2023.

Authors

Tingting Li^{1

2}, Wenjing Han^{1

2}, Xinlu Yang¹, Yu Wang¹, Li Peng¹, Lingwei He¹, Lianjia Hu¹, Jiayuan Liu¹, Min Xia¹, Sheng Wang^{1

2}

Affiliations

¹ Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
² Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People's Republic of China.

Abstract

Purpose: This study aimed to explore the effects of different injection rates of propofol on postoperative cognition in elderly patients undergoing laparoscopic inguinal hernia repair.

Methods: A total of 180 elderly patients who planned to undergo laparoscopic inguinal hernia repair were randomly divided into three groups: slow injection of propofol (V_S-Group, 30 mg kg^-1 h^-1); medium injection of propofol (V_M-Group, 100 mg kg^-1 h^-1) or fast injection of propofol (V_F-Group, 300 mg kg^-1 h^-1). Propofol was induced by microinfusion pump, and the depth of anesthesia was monitored by bispectral index (BIS). Propofol and remifentanil were continuously infused during anesthesia maintenance and adjusted according to BIS. The primary outcome was the use of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to measure the incidence of postoperative cognitive decline (POCD) in elderly patients on the first and seventh postoperative day. Secondary outcomes included induced dose of propofol, incidence of burst suppression and maximum electroencephalographic (EEG) effect of propofol (BIS-min) during induction.

Results: The incidence of POCD on the first and seventh day postoperatively was similar among the three groups (P > 0.05). However, with the increase of propofol injection rate, induced dose of propofol, incidence of burst suppression and BIS-min during induction, the number of patients requiring vasoactive agents were significantly increased (P < 0.001). Multivariate regression analysis showed that the brief duration of burst suppression during induction did not affect the occurrence of POCD, while age and duration of hospitalization were risk factors for POCD.

Conclusion: For elderly patients undergoing laparoscopic inguinal hernia repair, lowering the injection rate of propofol (such as 30 mg kg^-1 h^-1) cannot decrease the incidence of early POCD, but reduces induction dose of propofol and use of vasoactive drugs, making the patient's hemodynamics more stable.

Keywords: bispectral index; burst suppression; elderly; injection rate; postoperative cognitive decline; propofol.

Publication types

Randomized Controlled Trial
Case Reports
Clinical Trial

MeSH terms

Aged
Anesthetics, Intravenous / adverse effects
Cognition
Delirium*
Hernia, Inguinal* / chemically induced
Hernia, Inguinal* / surgery
Humans
Laparoscopy*
Postoperative Complications / epidemiology
Propofol* / adverse effects

Substances

Propofol
Anesthetics, Intravenous

Grants and funding

This study was funded by the National Natural Science Foundation of China (81860249).