A randomized comparative study to evaluate the effects of propofol versus desflurane on postoperative cognitive dysfunction in elderly patients undergoing elective spine surgeries under general anesthesia at Sawai Man Singh medical college Jaipur

Postoperative Cognitive Dysfunction refers to a condition where patients experience a decline in cognitive function after undergoing surgery. This decline can manifest as problems with memory, attention, concentration, and overall cognitive abilities. POCD is particularly observed in elderly patients, although it can also affect younger individuals. The duration of POCD can vary from a few days to several weeks or months post-surgery. Among the various factors influencing POCD, the choice of anaesthetic agents has garnered considerable attention in recent research. Use of intravenous and inhalational anaesthetic agents as maintenance anaesthesia have been extensively studied in relation to Postoperative Cognitive Dysfunction (POCD), reflecting their widespread use in surgical procedures and potential impact on cognitive function. In this study, we prospectively evaluate the effects of propofol versus desflurane on Post Operative Cognitive Dysfunction in elderly patients undergoing elective spine surgeries. This study will be conducted in two groups(Group A and Group B). Each group consists of 75 patients. Group A patients will receive propofol as maintenance anaesthetic agent and Group B patients will receive desflurane as maintenance anaesthetic agent.

Patient will be identified, PAC will be checked, MOCA(Montreal Cognitive Assessment) test will be done to get pre operative MOCA score, informed written consent will be taken and patient will be taken inside the OT. Pre-operative vitals (PR, NIBP, ECG, SpO2) will be recorded. IV fluids will be started through already secured IV line as per hospital protocol.Premedication will be given with Inj. Midazolam 0.05mg/kg IV, Inj. Glycopyrrolate 0.005mg/kg IV, Inj. Fentanyl 2 µg/kg  IV. Patient will be induced with Inj. Thiopentone(5-7mg/kg) IV + Inj. Rocuronium(0.6-1.2mg/kg) IV. Airway will be secured with Endotracheal Tube of appropriate size. Group A (N= 75) patients will receive propofol 50-200mcg/kg/min as maintenance anaesthesia along with N2O:O2(50:50) titrated to maintain BIS score between 40-60. Group B(N=75) patients will receive desflurane 2.5-8.5% as maintenance anaesthesia along with N2O:O2(50:50) titrated to maintain BIS score between 40-60. Hemodynamic parameters will be recorded throughout the surgery at fixed intervals. At the end of surgery, patient will be reversed with Inj. Neostigmine 0.06mg/kg and Inj. Glycopyrrolate 0.001mg/kg IV. Patient will be extubated after the patient is satisfying extubation criteria. Additionally, 4 mg of ondansetron will be administered to prevent postoperative nausea and vomiting and patients will be transferred to the post-anaesthesia care unit (PACU). Data collection after one week of surgery using MOCA(Montreal Cognitive Assessment) Score will be done and recording incidence of POCD, mean POCD score and score in various domains of cognitive function.