Comparison of pharmacological neuroprotection provided by propofol versus desflurane for long term postoperative cognitive dysfunction in patients undergoing surgery for aneurysmal subarachnoid hemorrhage

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is an acute life threatening condition with 30-40% mortality rate. Amongst the survivors, 40-50% suffers disability due to cognitive decline affecting quality of life on long term basis. The present concept of definite early intracranial aneurysm surgery poses challenges to anesthesiologist. During intracranial aneurysmal surgery, propofol and desflurane commonly used anesthetic agents. There is lack of data pertaining to anesthetic agents and cognitive sequelae following these agents. Methods: Randomized prospective comparative study enrolled 100 patients. Both the groups had 50 patients each. Cognition was assessed using Hindi version of MoCA test at three time points – Preoperatively, at the time of discharge, 1 month following surgery. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS version 22.0 for windows). Results: Preoperatively mean cognitive scores were 21.64 ± 4.40. Following discharge from the hospital, there was further decrease in mean cognitive scores. One month following surgery, mean cognitive dysfunction scores in propofol and desflurane were 22.63 ± 3.57 and 20.74 ± 3.89 (p = 0.04). Individual cognitive domain assessment showed memory and orientation scores were better in propofol group when compared to desflurane group (p = 0.03 and 0.01 respectively). Conclusion: The mean cognitive dysfunction scores at one month following surgery were higher with propofol as compared to desflurane. On subgroup analysis, orientation and memory scores were better preserved with propofol when compared to desflurane. Limitation of our study we assessed cognitive functions by using MoCA test. Although this test covers various domains of cognition but it does not evaluate individual domains in detail. Hence more comprehensive scale will identify the subtle differences in the individual component and may help in planning the rehabilitation of the aSAH patient.