Total Intravenous Versus Volatile Induction and Maintenance of Anesthesia in Elective Carotid Endarterectomy: Effects on Cerebral Oxygenation and Cognitive Functions

Objective: Carotid endarterectomy (CEA) is effective for the prevention of stroke, yet can be associated with a postoperative cognitive dysfunction (POCD) that may be affected by the type of anesthesia. The aim of the study was to compare the effects of total intravenous anesthesia (TWA) with propofol to volatile induction and maintenance of anesthesia (VIMA) with sevoflurane on cerebral tissue oxygen saturation (SctO(2)) and POCD. Design: Single-center, pilot randomized prospective study. Settings: Single-center, 1,000-bed clinical hospital. Participants: The study included 40 adult male patients. Interventions: None. Measurements and Main Results: Patients were randomized to the TIVA (n = 20) or the VIMA (n = 20) groups. Cardiorespiratory parameters and SctO(2) were monitored during CEA and through 20 hours postoperatively. Cognitive functions were assessed preoperatively and on days 1 and 5 after CEA using the Montreal Cognitive Assessment Score (MoCA). In both groups, the ipsilateral SctO(2) decreased after clamping, whereas the contralateral SctO(2) asymmetrically decreased in the TWA group only compared both with baseline and with the VIMA group. The changes in MoCA by day 1 correlated with the relative change in the ipsilateral SctO(2) after the clamping in the TWA group (p = 0.54, p = 0.015). The improvement of MoCA from days 1 to 5 was related to the relative decline in MAP after the clamping. Better cognitive function was observed by day 5 after sevoflurane VIMA compared with TIVA. Conclusion: In CEA, VIMA with sevoflurane might preserve oxygenation in the contralateral hemisphere, suppress an asymmetry of cerebral oxygenation, and improve the early postoperative cognition compared with propofol anesthesia. (C) 2017 Elsevier Inc. All rights reserved.