Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 10 10 1607 1607 Isak lambas Department of Anesthesiology and Intensive Therapy, Universitas Sumatera Utara, Medan, Indonesia. RR Irina Department of Anesthesiology and Intensive Therapy, Universitas Sumatera Utara, Medan, Indonesia. Chrismas Bangun Department of Anesthesiology and Intensive Therapy, Universitas Sumatera Utara, Medan, Indonesia. Yuki Yunanda Department of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia. 2026 03 29 2026 05 15 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. https://aacc.tums.ac.ir/index.php/aacc/article/view/1607