ISOFLURANE V\S SEVOFLURANE EFFECT ON POST OPERATIVE COGNITIVE DYSFUNCTIONN IN ADULT PATIENTS UNDERGOING LAPROSCOPIC SURGERIES: A COMPARATIVE-CROSS SECTIONAL STUDY

Abstract

Background: Postoperative cognitive dysfunction (POCD) describes a decline in cognitive performance after surgery and anesthesia. Volatile anesthetic agents may differ in their recovery profiles and potential effects on cognition. This study compared postoperative cognitive test performance in adults receiving isoflurane or sevoflurane during laparoscopic surgery.

Methods: A comparative cross-sectional study was conducted in CDA Hospital, Islamabad, and DHQ Hospital, Bhakkar, from September to December 2024. One hundred adults aged 20–50 years with American Society of Anesthesiologists physical status I–II were included; 50 received isoflurane and 50 received sevoflurane. Postoperative cognition was assessed using the Trail Making Test, Controlled Oral Word Association Test, Letter Cancellation Test, Rey Auditory Test, and a perception test. Data were analyzed descriptively, with the thesis reporting selected group comparisons.

Results: The sample comprised 60 men (60%) and 40 women (40%); 72 (72%) were married and 87 (87%) were educated. Normal Trail Making Test performance was observed in 43/50 (86%) isoflurane patients and 47/50 (94%) sevoflurane patients; compromised performance occurred in 7 (14%) and 3 (6%), respectively (reported p=0.159). Normal verbal fluency was recorded in 38/50 (76%) and 45/50 (90%), while compromised fluency occurred in 12 (24%) and 5 (10%), respectively (p=0.054). Normal Letter Cancellation performance was 41/50 (82%) versus 43/50 (86%); mild compromise was 5 (10%) in each group, and marked compromise was 4 (8%) versus 2 (4%). Normal Rey Auditory performance was 33/50 (66%) versus 37/50 (74%); mild compromise was 7 (14%) versus 11 (22%), and marked compromise was 10 (20%) versus 2 (4%). Normal perception was recorded in 36/50 (72%) versus 43/50 (86%); mild compromise in 9 (18%) versus 6 (12%); and marked compromise in 5 (10%) versus 1 (2%) (reported p=0.052).

Conclusion: Across all five assessments, the sevoflurane group had a higher proportion of normal postoperative test performance. These descriptive findings suggest better early postoperative cognitive test performance with sevoflurane in this sample; however, the cross-sectional design, absence of reported preoperative baseline scores, and incomplete inferential statistics prevent a causal conclusion or a definitive determination of POCD incidence.