EFFECTS OF DIFFERENT TYPES OF ANESTHESIA ON CEREBRAL OXYGENATION AND COGNITIVE FUNCTIONS IN CAROTID ENDARTERECTOMY

Abstract

Carotid endarterectomy (CEA) can be followed by postoperative cognitive dysfunction (POCD). Goal of the study: to investigate the effect of total intravenous anesthesia (TIVA) with propofol and inhalation anesthesia (IA) with sevoflurane on cerebral oxygenation and POCD. Materials and methods. 40 patients were enrolled into the study and divided into the groups of TIVA and IA. The cerebral tissue oxygen saturation with oxygen (SctO2) was recorded during CEA and in 24 hours after it. Cognitive functions were assessed with Montreal Cognitive Assessment (MoCA) before the CEA, in 1 and 5 days after. Results. Reduction of SctO2 was observed on the operated side after carotid clamping. SctO2 transitory reduced on the contralateral side in the TIVA group and was significantly higher in the IA group. MoCA changes in 24 hours after the surgery correlated with SctO2 reduction on the ipsilateral side in TIVA group (rho = 0.54; p = 0.015). In 5 days after CEA, the cognitive functions were higher in the IA group (p = 0.028). Conclusion. Anesthesia with sevoflurane used for CEA may mitigate an asymmetry of cerebral perfusion, improves oxygenation of contralateral hemisphere and reduces the risk of POCD.

Keywords

• carotid endarterectomy
• volatile induction and maintenance of anesthesia
• cerebral oxymetry
• postoperative cognitive dysfunction