Comparison of Postoperative Inflammation, Oxidative Stress, Pain and Cognitive Impairment in Propofol and Sevoflurane: A Randomized Clinical Trial

Background: The choice of anesthetics is critical to guard brain functions, reduce complications associated with surgical operations, and provide superior-standard care and better patients’ quality of life. Objectives: To compare postoperative inflammatory response, oxidative stress, cognitive dysfunction and pain index in patients undergoing elective, non-cardiac, abdominal surgery using propofol or sevoflurane anesthesia. Methods: A prospective, parallel, randomized, double-blinded clinical trial was conducted from December 2021 to April 2023 on 44 patients undergoing elective abdominal surgeries and anesthetized with either infusion of propofol or inhalational sevoflurane at a tertiary Hospital, Blood samples were drawn from the patients before surgery, 1 and 24 hours after surgery. Inflammatory response was measured by using matrix metalloproteinase-9 (MMP-9), oxidative stress by utilizing superoxide dismutase (SOD), cognitive dysfunction by using S100 calcium-binding protein β (S100-β), neuron-specific enolase (NSE) levels and Montreal Cognitive Assessment score (MoCA-B), pain by applying the numerical pain rating scale (NPRS). Results: MMP-9 levels and SOD enzyme activities were significantly higher in propofol before surgery and 1 hour after surgery postoperatively compared to sevoflurane group, (P<0.05). Time to emerge from anesthesia and NPRS scores were significantly lower in propofol compared to sevoflurane group, (P<0.001). Postoperative nausea and vomiting were significantly lower in the propofol than in the sevoflurane group. Conclusion: Propofol infusion lowered postoperative pain scores, inflammatory response, and oxidative stress, shortened the time to emerge from anesthesia, and decreased incidence rates of vomiting and nausea in patients scheduled for elective, abdominal operations under the effect of general anesthetics.