INTRAOPERATIVE NEUROPLASTICITY: ROLE OF ANESTHETICS IN POSTOPERATIVE COGNITIVE DYSFUNCTION ( POCD) IN YOUNG ADULT

Background: Postoperative cognitive dysfunction (POCD) is predominantly studied in elderly populations,with limited focus on young adults. This trial investigates the impact of anesthetic techniques (propofol TIVA vs. sevoflurane) on POCD incidence in non-geriatric adults,emphasizing NMDA receptor modulation and neuroinflammation. Methods:In a double-blind randomized trial,20 ASA I-II patients (18–40 years) undergoing elective non-cardiac surgery (>2 hours) were allocated to propofol TIVA (n=10) or sevoflurane (n=10). Cognitive function was assessed preoperatively and at 24h,72h,and 7 days postoperatively using the Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT-A/B). Serum IL-6 and TNF- levels quantified neuroinflammation. Results: Sevoflurane correlated with higher POCD incidence at 24h (40% vs. 10%, p=0.04) and greater MoCA decline ( MoCA: 2.4±0.8 vs. 0.9±0.6; p<0.001). TMT-B completion time worsened in sevoflurane at 24h ( +28.6±6.2s vs.+8.3±4.1s;p=0.002).Neuroinflammation markers rose significantly in sevoflurane (IL-6: +35.2±4.1 pg/mL vs. +12.1±3.2 pg/mL; p<0.001). Propofol showed faster cognitive recovery by day 7. Conclusion: Propofol TIVA demonstrates superior neuroprotection against POCD in young adults, potentially via attenuated neuroinflammation and NMDA-mediated neuroplasticity modulation