The impact of anesthesia depths on early postoperative neurocognitive complications after total intravenous anesthesia (TIVA) remains controversial. In some studies investigating TIVA, anesthesiologists mainly achieve the target depth of anesthesia by adjusting the dose of propofol, whereas the doses of opioids remains comparable between different anesthetic depth groups, possibly resulting inadequate analgesia. This study is aimed to investigate the impact of different anesthesia depths maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio on the incidence of early postoperative neurocognitive complications in older patients undergoing noncardiac surgery.
Aged ≥ 65 years.
Scheduled to undergo noncardiac surgery expected to last ≥ 1 hour under general anesthesia.
Require patient-controlled intravenous analgesia after surgery.
Provide written informed consent.
Inability to communicate in the preoperative period because of coma, profound dementia, language barrier, or other reasons.
Previous history of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis.
Traumatic brain injury or neurosurgery.
Severe hepatic dysfunction (Child-Pugh class C), severe renal dysfunction (eGFR <30 ml/min/1.73 m2), or critical illness (preoperative American Society of Anesthesiologists physical status classification ≥IV).
Parallel
Light anesthesia
DrugAnesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio; the target BIS is 50.
Deep anesthesia
DrugAnesthesia will be maintained by target-controlled infusion of propofol and remifentanil at a fixed ratio; the target BIS is 35.
Incidence of delayed neurocognitive recovery
Cognitive function is assessed with the Montreal Cognitive Assessment (MoCA; scores range from 0 to 30, with higher scores indicating better cognitove function). A decrease of 1 SD or more from baseline is defined as cognitive decline.
Quality of recovery after surgery
Quality of recovery is assessed with the 15-item Quality of Recovery scale (QoR-15; scores range from 0 to 150, with higher scores indicating better quality of recovery).
Incidence of postoperative neurocognitive disorder
Cognitive function is assessed with the telephone MoCA (T-MoCA; scores range from 0 to 20, with higher scores indicating better cognitove function). A decrease of 1 SD or more from baseline is defined as cognitive decline.
Pain intensity within 3 days after surgery
Pain intensity is assessed twice daily (8:00-10:00, 18:00-20:00) with the numeric rating scale (NRS; scores range fro 0 to 10, with 0=no pain and 10=the worst pain).
Subjective sleep quality within 3 days after surgery
Subjective sleep quality is assessed once daily (8:00-10:00) with the numeric rating scale (NRS; scores range fro 0 to 10, with 0=the best sleep and 10=the worst sleep).
Percentage of ICU admission after surgery
Percentage of patients required ICU admission after surgery
Length of hospital stay after surgery
Length of hospital stay after surgery
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