• J. Cardiothorac. Vasc. Anesth. · Dec 2013

    Randomized Controlled Trial Comparative Study

    Cognitive Function and Oxidative Stress After Carotid Endarterectomy: Comparison of Propofol to Sevoflurane Anesthesia.

    • Konstantinos Kalimeris, Stefania Kouni, Georgia Kostopanagiotou, Tzortzis Nomikos, Elisabeth Fragopoulou, John Kakisis, Spyridon Vasdekis, Paraskevi Matsota, and Ageliki Pandazi.
    • Second Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Athens, Greece.
    • J. Cardiothorac. Vasc. Anesth.. 2013 Dec 1;27(6):1246-52.

    ObjectiveTo examine the antioxidant role of propofol in ischemia-reperfusion during carotid endarterectomy (CEA) and its influence on cognitive dysfunction after CEA.DesignA randomized prospective study.SettingSingle-center study in a university hospital.ParticipantsForty-four patients.InterventionsPatients underwent elective CEA under general anesthesia with either sevoflurane (group S, n = 21) or propofol (group P, n = 23).Measurements And Main ResultsCognitive function was assessed with the Mini-Mental State Examination (MMSE) before CEA, 1 hour after CEA, and 24 hours after CEA. Blood samples from the radial artery and the internal jugular vein were drawn before carotid clamping and 5 minutes following unclamping, and peripheral blood was obtained 24 hours postoperatively. Samples were analyzed for lactate, S100B, and P-selectin concentrations and for the antioxidative markers malondialdehyde/low-density lipoprotein ratio and nitrate + nitrite concentrations. Compared with group S, patients in group P exhibited a greater increase in their MMSE values 24 hours postoperatively. Patients who had their MMSE performance reduced at 24 hours also were significantly fewer in group P (13% v 43% in group S, p<0.05). Significantly lower levels of lactate and S100B were observed in arterial and jugular vein samples in group P. In addition, the jugular vein-arterial differences of malondialdehyde-to-low-density lipoprotein ratio and nitrates + nitrites concentrations were lower during propofol anesthesia.ConclusionsPropofol seemed to improve cognitive performance after CEA. This improvement was associated with decreased indices of ischemic cerebral damage and seemed to be due to antioxidative effect in the ischemic cerebral circulation.Copyright © 2013 Elsevier Inc. All rights reserved.

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