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Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance.

Publication ,  Journal Article
Villalobos, D; Reese, M; Wright, MC; Wong, M; Syed, A; Park, J; Hall, A; Browndyke, JN; Martucci, KT; Devinney, MJ; Acker, L; Moretti, EW ...
Published in: Br J Anaesth
August 2023

BACKGROUND: Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans. METHODS: This was a nested randomised controlled trial within a prospective cohort study; patients age ≥60 yr undergoing noncardiac/non-neurological surgery were randomised to isoflurane or propofol for anaesthetic maintenance. Cerebrospinal fluid (CSF) was collected via lumbar puncture before, 24 h, and 6 weeks after surgery. Cognitive testing was performed before and 6 weeks after surgery. Nonparametric methods and linear regression were used to evaluate CSF biomarkers and cognitive function, respectively. RESULTS: There were 107 subjects (54 randomised to isoflurane and 53 to propofol) who completed the 6-week follow-up and were included in the analysis. There was no significant effect of anaesthetic treatment group, time, or group-by-time interaction for CSF amyloid-beta (Aβ), tau, or phospho-tau181p levels, or on the tau/Aβ or p-tau181p/Aβ ratios (all P>0.05 after Bonferroni correction). In multivariable-adjusted intention-to-treat analyses, there were no significant differences between the isoflurane and propofol groups in 6-week postoperative change in overall cognition (mean difference [95% confidence interval]: 0.01 [-0.12 to 0.13]; P=0.89) or individual cognitive domains (P>0.05 for each). Results remained consistent across as-treated and per-protocol analyses. CONCLUSIONS: Intraoperative anaesthetic maintenance with isoflurane vs propofol had no significant effect on postoperative cognition or CSF Alzheimer's disease-related biomarkers within 6 weeks after noncardiac, non-neurological surgery in older adults. CLINICAL TRIAL REGISTRATION: NCT01993836.

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

August 2023

Volume

131

Issue

2

Start / End Page

328 / 337

Location

England

Related Subject Headings

  • tau Proteins
  • Prospective Studies
  • Propofol
  • Peptide Fragments
  • Isoflurane
  • Humans
  • Biomarkers
  • Anesthetics
  • Anesthesiology
  • Amyloid beta-Peptides
 

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Villalobos, D., Reese, M., Wright, M. C., Wong, M., Syed, A., Park, J., … Berger, M. (2023). Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance. Br J Anaesth, 131(2), 328–337. https://doi.org/10.1016/j.bja.2023.04.019
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

August 2023

Volume

131

Issue

2

Start / End Page

328 / 337

Location

England

Related Subject Headings

  • tau Proteins
  • Prospective Studies
  • Propofol
  • Peptide Fragments
  • Isoflurane
  • Humans
  • Biomarkers
  • Anesthetics
  • Anesthesiology
  • Amyloid beta-Peptides