Effect of Different Anesthetic Techniques on Mental Outcome in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Abstract

Objective: In this article, we aimed to test the hypothesis that maintenance of hemodynamic stability with anesthesia and no-touch aortic technique in off-pump coronary artery bypass graft surgery (CABG) may diminish postoperative mental complications in elderly patients. Material and Methods: Between June 2009 and December 2009, 88 elderly patients (53 males, 35 females; mean age 71±7 years; range 64 to 78 years) with a physical status of ASA II-III who underwent elective off-pump CABG surgery in our hospital's operating rooms and cardiovascular and thoracic intensive care units were included in this prospective randomized study with signed informed consents. Patients undergoing off-pump CABG surgery performed by a surgeon were randomly assigned into two groups, including total intravenous anesthesia (group TIVA, n=40; mean age 66±4) or inhalational anesthesia (group IA, n=40; mean age 69±3). The effect of off-pump CABG surgery on mental outcome was assessed with S100 protein, a neurochemical marker of brain injury under ischemic conditions. Comparison of mental function before and after off-pump CABG surgery, hemodynamic stability and time to discharge were the main outcomes of the study. Results: Hemodynamic values were stable in both groups. None of the patients showed marked increase in serum concentrations of S100 postoperatively (p<0.001). The mean total off-pump CABG time was 48±15 minutes in both groups. There was no difference between the groups in terms of time to discharge. Conclusion: We believe that well-performed hemodynamic stability with either intravenous or general anesthesia may offer a well-controlled mental function in elderly patients undergoing offpump CABG surgery. Copyright © 2017 by Türkiye Klinikleri.