The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients
Bibliographic record
Abstract
Background: The fast expanding demographic segment of the elderly population has resulted in an increase in the people aged 65 y and above, needing surgical treatments. This change has posed special medical problems including need of surgical management, while preventing postoperative complications. We compared the postoperative cognitive injury in older adults between total intravenous anesthesia (TIVA) and inhalational anesthesia. It lays the groundwork for anesthesiology and perioperative care research and clinical choices in elderly. Methodology: With exclusions for cognitive disabilities and neurologic disorders, participants of ≥ 65 y of age, scheduled for elective surgery, were randomly assigned to TIVA or inhalational anesthesia groups. Preoperative exams were carried out, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) cognitive tests. While the inhalation group got inhalational sevoflurane or desflurane with opioids, TIVA group received propofol and remifentanil IV. The incidence of Postoperative Cognitive Dysfunction (POCD) was the main outcome; while secondary outcomes included hospital stay, any complications, anesthesia and surgery durations and three-month mortality. Results: On days 1 and 3 postoperative cognitive scores (POCS) dropped dramatically; on day 7 in both TIVA and inhalational anesthesia groups, they rose again. On day 1, TIVA group patients demonstrated better cognitive scores than the inhalational group. On days 3 and 7, no appreciable changes were noted. By day 7, both groups showed notable cognitive improvement over preoperative levels. Conclusion: Though by day seven they recover, both TIVA and inhalational anesthesia cause cognitive problems following surgery. Early after surgery, TIVA enhances cognitive ability; but both techniques have identical long-term results. Our results imply that to improve cognitive recovery, elderly surgical patients require specially tailored anesthetic management. Abbreviations: MMSE: Mini-Mental State Examination, MoCA: Montreal Cognitive Assessment, POCD: Postoperative Cognitive Dysfunction, TIVA: total intravenous anesthesia, Keywords: Total Intravenous Anesthesia; Inhalational Anesthesia; Postoperative Cognitive Dysfunction; Elderly Patients; Cognitive Recovery Citation: Saeed AA, Al-Jenabi ZK. The effects of total intravenous vs inhalational anesthesia on postoperative cognitive dysfunction in elderly patients. Anaesth. pain intensive care 2025;29(2):226-231. DOI: 10.35975/apic.v29i2.2708 Received: September 02, 2024; Reviewed: October 23, 2024; Accepted: January 01, 2025
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".