Comparison of Sevoflurane and Propofol Administration on Postoperative Cognitive Dysfunction in Spinal Surgery Using the Mini-Mental State Examination (MMSE)
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Abstract
Background: Postoperative cognitive dysfunction (POCD; defined as >2-point MMSE decline from baseline) is common after general anesthesia in spinal surgery. This study compared sevoflurane vs. propofol effects on postoperative cognition.
Methods: Single-blind randomized controlled trial (1:1 allocation) with 20 adults undergoing elective spinal surgery under general anesthesia. Patients were assigned to sevoflurane (n=10) or propofol (n=10) maintenance. MMSE was assessed preoperatively and at 6 h, 24 h, 3 days, and 7 days postoperatively. Analysis: independent t-tests, chi-square, and Pearson correlation (p<0.05 significant).
Results: No statistically significant differences were noted in baseline characteristics (age, gender, education; p>0.05). While the MMSE test results in the propofol group were unchanged (Day 7: 28.3±2.4), there was a slight reduction (p=0.04). In the sevoflurane group, the decrease became significant on Day 3 (p=0.006) and Day 7 (p=0.004; score 25.4±3.5 vs. propofol p=0.04), with 60% having a mild POCD. The decline in sevoflurane group is associated with oxidative stress and hippocampal damage; propofol provides the antioxidative protection.
Conclusion: Propofol yields superior cognitive stability vs. sevoflurane post-spinal surgery, reducing POCD risk-recommend as the preferred agent.
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