Supplemental sedation with propofol or light general anesthesia with desflurane as adjuncts to general anesthesia in patients undergoing total hip replacement: a randomized pilot study assessing the effect on cognitive recovery
Background: Total hip replacement is a common procedure, but despite low incidences of mortality and major complications, these patients remain susceptible to postoperative cognitive decline. Our aim was to determine the impact of supplemental sedation and light general anesthesia to supplement spinal anesthesia, on cognitive recovery using “The Postoperative Quality of Recovery Scale”.
Methods: In a prospective, randomized pilot study, patients undergoing total hip replacement surgery under spinal anesthesia were included, and as an adjunct, patients were randomized to either propofol sedation or desflurane general anesthesia. Doses of propofol or desflurane were adjusted according to the requirements by the anesthetist.
Results: In total, 52 patients were randomized to either propofol (n=31) or desflurane (n=21). In both groups, cognitive recovery rates improved over time to 85% with propofol group and 100% with desflurane group after 3 months, with no apparent difference 3 days after surgery. Similarly, overall recovery rates improved to 79% in the propofol group and 83% in the desflurane group after 3 months. In the four remaining subdomains 3-month recovery rates in the propofol and the desflurane groups were: nociception; 97% and 100%, respectively, emotion; 90% and 90%, respectively, and activity-of-daily-living; 93% and 95%, respectively.
Conclusion: The use of desflurane general anesthesia to supplement spinal anesthesia for total hip replacement surgery might have a modest benefit for late but not early cognitive recovery compared to intravenous sedation with propofol.