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Obese patients are at increased risk of postoperative cognitive dysfunction (POCD). The effects of different anesthetic techniques on postoperative cognitive function remain controversial. This prospective randomized study aimed to compare the effects of low-flow sevoflurane anesthesia, normal-flow sevoflurane anesthesia, and total intravenous anesthesia (TIVA) on postoperative cognitive function and recovery characteristics in obese patients undergoing elective laparoscopic abdominal surgery. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) before surgery, at postoperative 30 minutes, and on postoperative day 3.
Obesity is associated with physiological alterations that may increase the risk of postoperative cognitive dysfunction (POCD). The influence of anesthetic techniques on postoperative cognitive outcomes in obese patients remains uncertain.
This prospective randomized study was conducted in obese patients (BMI ≥30 kg/m²) aged 18-65 years undergoing elective laparoscopic abdominal surgery under general anesthesia. Patients were randomly assigned to one of three groups: low-flow sevoflurane anesthesia, normal-flow sevoflurane anesthesia, or total intravenous anesthesia (TIVA). Anesthetic depth was monitored using bispectral index (BIS) monitoring and maintained between 40 and 60 in all groups.
The primary objective was to compare postoperative cognitive function among the three anesthetic techniques using the Mini-Mental State Examination (MMSE). MMSE scores were evaluated preoperatively, at postoperative 30 minutes, and on postoperative day 3.
Secondary objectives included comparison of recovery characteristics, including eye-opening time, extubation time, Modified Aldrete Recovery Scores, and perioperative hemodynamic parameters.
The study was approved by the Marmara University Faculty of Medicine Clinical Research Ethics Committee (Approval No. 09.2022.744) and written informed consent was obtained from all participants before enrollment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low-Flow Sevoflurane | Experimental | Patients received sevoflurane anesthesia with a fresh gas flow of 1 L/min during maintenance of anesthesia. Anesthetic depth was maintained with BIS values between 40 and 60. |
|
| Normal-Flow Sevoflurane | Experimental | Patients received sevoflurane anesthesia with a fresh gas flow of 3 L/min during maintenance of anesthesia. Anesthetic depth was maintained with BIS values between 40 and 60. |
|
| Total Intravenous Anesthesia (TIVA) | Experimental | Patients received total intravenous anesthesia with propofol and remifentanil infusion. Anesthetic depth was maintained with BIS values between 40 and 60. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sevoflurane (Volatile Anesthetic) | Drug | Maintenance of general anesthesia with sevoflurane inhalation. Patients were assigned to either low-flow (1 L/min) or normal-flow (3 L/min) fresh gas flow anesthesia protocols. |
| Measure | Description | Time Frame |
|---|---|---|
| Mini-Mental State Examination (MMSE) Score | Postoperative cognitive function assessed using the Mini-Mental State Examination (MMSE). | Preoperative, postoperative 30 minutes, and postoperative day 3 |
| Measure | Description | Time Frame |
|---|---|---|
| Eye Opening Time | Time from discontinuation of anesthetic administration to spontaneous eye opening | End of surgery |
| Extubation Time | Time from discontinuation of anesthetic administration to tracheal extubation. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ahmet Tunca, MD | Department of Anesthesiology and Reanimation, Gaziantep City Hospital | Principal Investigator |
| Seniyye Ü Zengin, MD | Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Pendik Training and Research Hospital | Study Chair |
| Meliha O Ergün, MD | Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Pendik Training and Research Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Marmara University Faculty of Medicine Pendik Training and Research Hospital | Istanbul | Istanbul | 34899 | Turkey (Türkiye) |
Individual participant data will not be made publicly available due to privacy and confidentiality considerations.
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| ID | Term |
|---|---|
| D009765 | Obesity |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D000077149 | Sevoflurane |
| D015742 | Propofol |
| D000077208 | Remifentanil |
| ID | Term |
|---|---|
| D008738 | Methyl Ethers |
| D004987 | Ethers |
| D009930 | Organic Chemicals |
| D006845 | Hydrocarbons, Fluorinated |
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Participants were randomly assigned to one of three parallel groups: low-flow sevoflurane anesthesia, normal-flow sevoflurane anesthesia, or total intravenous anesthesia (TIVA). Cognitive function was evaluated using the Mini-Mental State Examination before surgery, at postoperative 30 minutes, and on postoperative day 3.
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Participants were unaware of the anesthetic technique assigned to them. Postoperative cognitive assessments were performed by an outcome assessor blinded to group allocation. Anesthesia providers were aware of treatment allocation because of the nature of the interventions.
| propofol | Drug | Maintenance of total intravenous anesthesia using continuous propofol infusion under BIS monitoring. |
|
| Remifentanil | Drug | Continuous remifentanil infusion was administered during maintenance of anesthesia according to study protocol. |
|
| End of surgery |
| Modified Aldrete Recovery Score | Recovery status assessed using the Modified Aldrete Score. | Postoperative recovery period |
| heart rate | patient's intraoperative measured heart rate | During surgery |
| mean arterial pressure | patient's intraoperative measured mean arterial pressure | during surgery |
| oxygen saturation | oxygen saturation of the patient will be recorded | During surgery |
| end-tidal carbon dioxide | end-tidal carbon dioxide of the patient will be recorded | During surgery |
| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006846 |
| Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D011422 | Propionates |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |