Background It is unclear whether desflurane, one of the most-used volatile anesthetics in clinical practice, is less likely to induce postoperative cognitive dysfunction (POCD). We here compared early postoperative cognitive function of the isoflurane and desflurane patients and explored the diagnostic performance of relative level of LINC01844 in peripheral blood for POCD. Methods Eighty-five patients underwent lumbar surgery under general anesthesia were included in the study according to inclusion and exclusion criteria. Patients were randomly allocated to either isoflurane (I) or desflurane (D) study arms. A battery of 7-item neurocognitive tests was performed repeatedly on one day preoperatively and 1st, 3rd and 5th day postoperatively (POD1,3,5) and peripheral blood samples were drawn simultaneously. POCD was diagnosed using the Z-score method. The relative level of LINC01844 was decided by quantitative real-time polymerase chain reaction. The primary outcome was the incidence of POCD within 5 days postoperatively. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were used for the analysis of diagnostic performance of LINC01844 level for POCD. Results The incidence of POCD within 5 days postoperatively was significantly lower in D group than in the I group (p = 0.001). Compared to I group, LINC01844 relative levels in D group were significantly lower on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Patients diagnosed with POCD had higher LINC01844 relative level on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Binary logistic regression analysis found that POCD was independently associated with LINC01844 relative level of POD1, POD3 and POD5(OR 14.862, 95%CI 3.735–29.136, p<0.001; OR 2.383, 95%CI 1.506–3.769, p<0.001; OR 3.469, 95%CI 1.744–6.902, p<0.001, respectively). The ROC curves showed that the areas under the curve for LINC01844 relative levels on POD1, POD3 and POD5 were 0.946(95%CI: 0.900-0.992, p<0.001), 0.795(95%CI: 0.675–0.915, p<0.001) and 0.769(95%CI: 0.654–0.885, p<0.001), respectively. Conclusion Desflurane had less impact on postoperative cognitive function of the elderly patients and had less interference with expression of LINC01844. The relative level of LINC01844 in peripheral blood may be a potential biomarker for POCD. Trial registration Registered with ClinicalTrials.gov (NCT06387836, principal investigator: Shengjin Ge; April 2024).

Impact of desflurane versus isoflurane on early cognitive function of the elderly undergoing lumbar surgery: a randomized clinical trial

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2025年12月9日

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Danfeng Jin,
Yuanyuan Ma,
Yelong Ji,
Shengjin Ge

摘要

Background

It is unclear whether desflurane, one of the most-used volatile anesthetics in clinical practice, is less likely to induce postoperative cognitive dysfunction (POCD). We here compared early postoperative cognitive function of the isoflurane and desflurane patients and explored the diagnostic performance of relative level of LINC01844 in peripheral blood for POCD.

Methods

Eighty-five patients underwent lumbar surgery under general anesthesia were included in the study according to inclusion and exclusion criteria. Patients were randomly allocated to either isoflurane (I) or desflurane (D) study arms. A battery of 7-item neurocognitive tests was performed repeatedly on one day preoperatively and 1st, 3rd and 5th day postoperatively (POD1,3,5) and peripheral blood samples were drawn simultaneously. POCD was diagnosed using the Z-score method. The relative level of LINC01844 was decided by quantitative real-time polymerase chain reaction. The primary outcome was the incidence of POCD within 5 days postoperatively. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were used for the analysis of diagnostic performance of LINC01844 level for POCD.

Results

The incidence of POCD within 5 days postoperatively was significantly lower in D group than in the I group (p = 0.001). Compared to I group, LINC01844 relative levels in D group were significantly lower on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Patients diagnosed with POCD had higher LINC01844 relative level on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Binary logistic regression analysis found that POCD was independently associated with LINC01844 relative level of POD1, POD3 and POD5(OR 14.862, 95%CI 3.735–29.136, p<0.001; OR 2.383, 95%CI 1.506–3.769, p<0.001; OR 3.469, 95%CI 1.744–6.902, p<0.001, respectively). The ROC curves showed that the areas under the curve for LINC01844 relative levels on POD1, POD3 and POD5 were 0.946(95%CI: 0.900-0.992, p<0.001), 0.795(95%CI: 0.675–0.915, p<0.001) and 0.769(95%CI: 0.654–0.885, p<0.001), respectively.

Conclusion

Desflurane had less impact on postoperative cognitive function of the elderly patients and had less interference with expression of LINC01844. The relative level of LINC01844 in peripheral blood may be a potential biomarker for POCD.

Trial registration

Registered with ClinicalTrials.gov (NCT06387836, principal investigator: Shengjin Ge; April 2024).