Comparison of the Effect of Propofol and Midazolam on Cognitive Performance in Elderly Patients Undergoing Spinal Anesthesia: A Double-Blind Clinical Trial
-
Nahid Manouchehrian
,
Maryam Davoudi
,
Hossein Kimiaei Asadi
,
Ali Daneshkhah
,
Latif Moradveisi
,
Nasrin Jiryaee
Abstract
Background: The effects of anesthetics on memory have not yet been completely clear, and there have been some discrepancies on this issue in the literature. This study aimed to compare the effect of two sedatives, Propofol and Midazolam, on the incidence of cognitive dysfunction in elderly patients undergoing spinal anesthesia.
Methods: This double-blind clinical trial was conducted on 136 elderly patients who underwent spinal anesthesia in Besat Hospital, Hamadan, Iran, during 2020-21. The patients were randomly assigned into two groups of Propofol (0.2 mg/kg) and Midazolam (0.02 mg/kg). The Wechsler Memory Scale-III (WMS-III) were utilized to assess the cognitive dysfunction and memory coefficient in the two groups.
Results: There was no significant difference between the two groups in terms of short and long-term memory, as well as cognitive dysfunction before and after spinal anesthesia (P>0.05). The time of onset of sedation (Z=-11.11; P<0.005) and recovery from sedation (Z=-10.56; P<0.005) were longer in the Midazolam group, compared to the Propofol group. There were no significant differences between the two groups before and after operation regarding the WMS-III categories (P>0.05). The comparison of the two groups in terms of memory coefficient after operation showed no significant differences between them in this regard (Z=-0.63; P=0.52).
Conclusion: Midazolam and Propofol showed no differences regarding the effects on the postoperative memory coefficient or cognitive dysfunction.
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[5] FodaleV, Santamaria LB, Schifiliti D, Mandal PK. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease. Anaesthesia. 2010; 65(4): 388-395.
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[8] Grunebaum MF, Ellis SP, Keilp JG, Moitra VK, Cooper TB, Marver JE, et al. Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam-controlled randomized clinical trial. Bipolar Disord. 2017; 19(3):176-183.
[9] Qiu Q, Choi SW, Wong SS, Irwin MG, Cheung CW. Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes–a systematic review and meta‐analysis. Surv Anesthesiol. 2017 ;61(1):9-10.
[10] Kushwaha R, Choudhary S. A comparative study between propofol and thiopentone for hemodynamic parameters during induction of general anesthesia in surgical patients. J med pharm allied sci. 2017; 7(1): 9.
[11] Yaraghi A, Sajedi P, Beygi A. Comparison of sedative effect of midazolam and propofol in patients with renal failure. Shahrekord University of Medical Sciences Journal. 2008; 9(4):13-19.
[12] Monk TG, Weldon BC, Garvan CW, Dede DE, Vander Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18-30.
[13] Evered L. Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesthesia & Analgesia.2011;112(5):1179-85.
[14] Krenk L, Kehlet H, Baek Hansen T, Solgaard S, Soballe K, Rasmussen LS. Cognitive dysfunction after fast-track hip and knee replacement. Anesthesia & Analgesia. 2014; 118(5): 1034-1040.
[15] Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X, et al. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Med Sci Monit. 2014; 20: 1908-12.
[16] Mardini F, Arroliga M, Tang J, Eckenhoff R, Eckenhooff MF. Propofol anesthesia reduces long-term cognitive impairment due to surgery in the 3xTgAD murine model of Alzheimer's disease. Alzheimer's & Dementia. 2012; 8(4): 196-197.
[17] Lee IH, Culley DJ, Baxter MG, Xie Z, Tanzi RE, Crosby G. Spatial memory is intact in aged rats after propofol anesthesia. Anesthesia & Analgesia. 2008. 107(4): 1211-1215.
[18] Wang J, Niu M, Bai S. Effects of long-term infusion of sedatives on the cognitive function and expression level of RAGE in hippocampus of rats. J Anesth. 2016; 30(4): 691-695.
[19] Maldonado JR, Wysong A, Van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative deliriumafter cardiac surgery. Psychosomatics. 2009; 50(3): 206-217.
[20] Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wismandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301(5): 489-499.
[21] Shao H, Zhang Y, Dong Y, Yu B, Xia W, Xie Z, et al. Chronic treatment with anesthetic propofol improves cognitive function and attenuates caspase activation in both aged and Alzheimer's disease transgenic mice. J Alzheimer's Dis. 2014; 41(2): 499-513.
[22] Clark G, Licker M, Younossian MB, Soccal PM, Frey JG, Rochat T, et al. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial. Eur Res J. 2009; 34(6): 1277-1283.
[23] Veselis RA, Reinsel RA, Feshchenko VA, Wroński M. The comparative amnestic effects of midazolam, propofol, thiopental, and fentanyl at equisedative concentrations. Anesthesiology. 1997; 87(4):749-64.
[24] Li WX, Luo RY, Chen C, Li X, Ao JS, Liu Y, et al. Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients: a randomized controlled preliminary trial. Chin Med J. 2019; 132(4): 437-445.
[25] Wilson E, David A, Mackenzie N, Grant IS. Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth. 1990; 64(1): 48-52.
[26] Zaal IJ, Devlin JW, Hazelbag M, Klein Klouwenberg PM, van der Kooi AW, Ong DS, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med. 2015 Dec;41(12):2130-7.
[27] Bhosale JP, Trumboo ON, Aphale S. Comparison of Propofol and Midazolam infusion for conscious sedation during spinal anaesthesia. J Med Dent Sci Res. 2015; 2(1): 19-24.
[28] Sieber FE, Neufeld KJ, Gottschalk A, Bigelow GE, Oh ES, Rosenberg PB. Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium: The stride Randomized Clinical Trial. JAMA surgery. 2018. 153(11): 987-995.
[29] Konishi Y, Evered LA, Silbert BS. Postoperative cognitive dysfunction after sevoflurane or propofol general anaesthesia in combination with spinal anaesthesia for hip arthroplasty. Anaesth Intensive Care. 2018; 46(6): 596-600.
[30] Sarasin D, Ghoneim M, Block R. Effects of sedation with midazolam or propofol on cognition and psychomotor functions. J Oral Maxillofac Surg. 1996; 54(10): 1187-1193.
[31] Padmanabhan U, Leslie K, Singyi Eer A, Maruff P, Silbert BS. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesthesia & Analgesia.2009; 109(5): 1448-1455.
[32] AmiriHR, Maghsoodloo M. Comparison of Bispecteral index relation with amnesia during Midazolam and Midazolam-Propofol sedation in 107 regional/local anesthesia. J Iranian Society Anesthesiology and Intensive Care. 2005; 27(52):15-21.
[33] Mohammadalizadeh A, Farhanchi A, Falah M, Seyed TZ, safari F. Comparative evaluation of conscious sedation effect of propofol versus midazolam in endoscopic and colonoscopic procedures. J Zanjan University of Medical Sciences and Health Services. 2002; 10(40):29-34.
[34] Evered L, Silbert B, Knopman DS, Scott DA, Dekosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018. Anesthesiology. 2018; 129(5): 872-879.
[2] Strøm C, Rasmussen L, Sieber F. Should general anaesthesia be avoided in the elderly? Anaesthesia. 2014; 69: 35-44.
[3] Kim JE. Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine on low-dose bupivacaine spinal anesthesia in elderly patients undergoing transurethral prostatectomy. Biol Pharm Bull. 2013; 36(6): 959-965.
[4] Khalili G, Janghorbani M, Sajedi P, Ahmadi G. Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: a randomized, double-blind trial in patients undergoing lower extremity surgery. J Anesth. 2011;25(6): 892-7.
[5] FodaleV, Santamaria LB, Schifiliti D, Mandal PK. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease. Anaesthesia. 2010; 65(4): 388-395.
[6] Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB. Sedation depth during spinal anaethesia and the development of postoperative delirium in elderly patients undergoing Hip fracture repair. Mayo Clin Proc. 2010; 85(1):18-26.
[7] Rasmussen LS, Moller JT. Central nervous system dysfunction after anesthesia in the geriatric patient. Anesthesiol Clin North Am. 2000; 18(1):59-70
[8] Grunebaum MF, Ellis SP, Keilp JG, Moitra VK, Cooper TB, Marver JE, et al. Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam-controlled randomized clinical trial. Bipolar Disord. 2017; 19(3):176-183.
[9] Qiu Q, Choi SW, Wong SS, Irwin MG, Cheung CW. Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes–a systematic review and meta‐analysis. Surv Anesthesiol. 2017 ;61(1):9-10.
[10] Kushwaha R, Choudhary S. A comparative study between propofol and thiopentone for hemodynamic parameters during induction of general anesthesia in surgical patients. J med pharm allied sci. 2017; 7(1): 9.
[11] Yaraghi A, Sajedi P, Beygi A. Comparison of sedative effect of midazolam and propofol in patients with renal failure. Shahrekord University of Medical Sciences Journal. 2008; 9(4):13-19.
[12] Monk TG, Weldon BC, Garvan CW, Dede DE, Vander Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18-30.
[13] Evered L. Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesthesia & Analgesia.2011;112(5):1179-85.
[14] Krenk L, Kehlet H, Baek Hansen T, Solgaard S, Soballe K, Rasmussen LS. Cognitive dysfunction after fast-track hip and knee replacement. Anesthesia & Analgesia. 2014; 118(5): 1034-1040.
[15] Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X, et al. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Med Sci Monit. 2014; 20: 1908-12.
[16] Mardini F, Arroliga M, Tang J, Eckenhoff R, Eckenhooff MF. Propofol anesthesia reduces long-term cognitive impairment due to surgery in the 3xTgAD murine model of Alzheimer's disease. Alzheimer's & Dementia. 2012; 8(4): 196-197.
[17] Lee IH, Culley DJ, Baxter MG, Xie Z, Tanzi RE, Crosby G. Spatial memory is intact in aged rats after propofol anesthesia. Anesthesia & Analgesia. 2008. 107(4): 1211-1215.
[18] Wang J, Niu M, Bai S. Effects of long-term infusion of sedatives on the cognitive function and expression level of RAGE in hippocampus of rats. J Anesth. 2016; 30(4): 691-695.
[19] Maldonado JR, Wysong A, Van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative deliriumafter cardiac surgery. Psychosomatics. 2009; 50(3): 206-217.
[20] Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wismandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301(5): 489-499.
[21] Shao H, Zhang Y, Dong Y, Yu B, Xia W, Xie Z, et al. Chronic treatment with anesthetic propofol improves cognitive function and attenuates caspase activation in both aged and Alzheimer's disease transgenic mice. J Alzheimer's Dis. 2014; 41(2): 499-513.
[22] Clark G, Licker M, Younossian MB, Soccal PM, Frey JG, Rochat T, et al. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial. Eur Res J. 2009; 34(6): 1277-1283.
[23] Veselis RA, Reinsel RA, Feshchenko VA, Wroński M. The comparative amnestic effects of midazolam, propofol, thiopental, and fentanyl at equisedative concentrations. Anesthesiology. 1997; 87(4):749-64.
[24] Li WX, Luo RY, Chen C, Li X, Ao JS, Liu Y, et al. Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients: a randomized controlled preliminary trial. Chin Med J. 2019; 132(4): 437-445.
[25] Wilson E, David A, Mackenzie N, Grant IS. Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth. 1990; 64(1): 48-52.
[26] Zaal IJ, Devlin JW, Hazelbag M, Klein Klouwenberg PM, van der Kooi AW, Ong DS, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med. 2015 Dec;41(12):2130-7.
[27] Bhosale JP, Trumboo ON, Aphale S. Comparison of Propofol and Midazolam infusion for conscious sedation during spinal anaesthesia. J Med Dent Sci Res. 2015; 2(1): 19-24.
[28] Sieber FE, Neufeld KJ, Gottschalk A, Bigelow GE, Oh ES, Rosenberg PB. Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium: The stride Randomized Clinical Trial. JAMA surgery. 2018. 153(11): 987-995.
[29] Konishi Y, Evered LA, Silbert BS. Postoperative cognitive dysfunction after sevoflurane or propofol general anaesthesia in combination with spinal anaesthesia for hip arthroplasty. Anaesth Intensive Care. 2018; 46(6): 596-600.
[30] Sarasin D, Ghoneim M, Block R. Effects of sedation with midazolam or propofol on cognition and psychomotor functions. J Oral Maxillofac Surg. 1996; 54(10): 1187-1193.
[31] Padmanabhan U, Leslie K, Singyi Eer A, Maruff P, Silbert BS. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesthesia & Analgesia.2009; 109(5): 1448-1455.
[32] AmiriHR, Maghsoodloo M. Comparison of Bispecteral index relation with amnesia during Midazolam and Midazolam-Propofol sedation in 107 regional/local anesthesia. J Iranian Society Anesthesiology and Intensive Care. 2005; 27(52):15-21.
[33] Mohammadalizadeh A, Farhanchi A, Falah M, Seyed TZ, safari F. Comparative evaluation of conscious sedation effect of propofol versus midazolam in endoscopic and colonoscopic procedures. J Zanjan University of Medical Sciences and Health Services. 2002; 10(40):29-34.
[34] Evered L, Silbert B, Knopman DS, Scott DA, Dekosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018. Anesthesiology. 2018; 129(5): 872-879.
| Files | ||
| Issue | Vol 9 No 2 (2023): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i2.12512 | |
| Keywords | ||
| Elderly Postoperative Cognitive Dysfunction Propofol Midazolam Spinal Anesthesia | ||
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How to Cite
1.
Manouchehrian N, Davoudi M, Kimiaei Asadi H, Daneshkhah A, Moradveisi L, Jiryaee N. Comparison of the Effect of Propofol and Midazolam on Cognitive Performance in Elderly Patients Undergoing Spinal Anesthesia: A Double-Blind Clinical Trial. Arch Anesth & Crit Care. 2022;9(2):138-146.
