This clinical trial investigates whether desflurane induces postoperative cognitive dysfunction (POCD) in elderly patients undergoing perioperative procedures by modulating Cdc42 and Clock proteins. The primary research questions are: (1) Does desflurane administration contribute to POCD in this patient population? and (2) Are alterations in Cdc42 and Clock protein levels associated with desflurane-induced POCD in elderly patients? To address these questions, elderly patients will be administered desflurane for anesthesia maintenance. Postoperative assessments will then compare blood levels of Cdc42 and Clock proteins, and examine related signaling pathways, between a control group and a POCD group.
Study participants will receive desflurane anesthesia maintained at a Bispectral Index (BIS) value of 40-60. Postoperative cognitive function will be assessed on the second day using the Montreal Cognitive Assessment (MoCA), and participants will be categorized into either a control group or a POCD group based on MoCA performance. Cognitive function and blood levels of Cdc42 and Clock proteins will be recorded. Furthermore, the study will also investigate associated signaling pathways.
Age > 70 years
American Society of Anesthesiologists (ASA) physical status classification I-III
Scheduled to undergo elective surgery requiring general anesthesia with desflurane
Able and willing to provide voluntary written informed consent
Pre-existing diagnosis of dementia or any other neurodegenerative disease that could affect cognitive function
Preoperative Montreal Cognitive Assessment (MoCA) score < 20
History of severe psychiatric disorders, including psychosis, severe depression, or bipolar disorder
Unstable angina, uncontrolled hypertension, or a history of myocardial infarction within the past 6 months
Parallel
Desflurane Inhalation
DrugAnesthesia was maintained with either desflurane, with inhaled concentrations adjusted based on electroencephalogram (EEG) monitoring.
mechanical ventilation (MV)
DeviceFollowing induction, patients underwent mechanical ventilation in volume-controlled (VC) mode. Ventilation parameters were set using a GE Aestiva anesthesia machine (GE Healthcare, Waukesha, Wisconsin, USA): tidal volume 6-8 ml/kg, positive end-expiratory pressure 0 cmH2O, inspiration/expiration ratio 1:2, respiratory rate 16 breaths/min, and inspired oxygen concentration of 41%.
Montreal Cognitive Assessment (MoCA)
MoCA, is a rating system from 0 to 30, where 0 represents "no postoperative cognitive dysfunction" and 30 represents the worst possible postoperative cognitive dysfunction.
Cell division control protein 42 homolog (Cdc42) and Circadian Locomotor Output Cycles Kaput(Clock)
The normal ranges of Cdc42 and Clock were consistent with preoperative levels. The higher the value, the greater the POCD, and the worse the outcome.
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Xiaguang Duan
Lead sponsor
Inner Mongolia Baogang Hospital
Sponsor institution
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