Evaluation of the the effects of total intravenous anesthesia and inhalation anesthesia techniques on mini mental state examination test and neuron specific enolase level in lumbar disc herniectomy operations

Aim: The aim of this study is to compare the effects of total intravenous anesthesia and inhalation anesthesia methods which are general anesthesia methods on postoperative cognitive dysfunction according to Mini Mental State Examination scores and Neuron Specific Enolase levels in lumbar disc herniectomy operations. Materials and Methods: Our study was performed in the Department of Anesthesiology and Reanimation, Erzincan Mengücek Gazi Education and Research Hospital between 20.02.2018-20.08.2019. Eighty patients aged between 18-65 years in ASA I, II and III risk groups who underwent elective lumbar disc herniectomy surgeries were included in the study. MMSE test was applied to patients preoperatively and venous blood samples were taken for NSE measurement. Patients were divided into two groups as T and I according to applied anesthesia technique. Forty patients administered sevoflurane for maintenance were included in Group I and forty patients administered TIVA using remifentanil and propofol for maintenance were included in group T. MMSE test was applied to the patients in the postoperative 1 st hour. MMSE test was performed again at postoperative 24th hour and venous blood samples were taken for NSE measurement. Results: The mean preoperative MMSE scores was statistically similar in both groups. MMSE scores were found to be similar in the Group T at the preoperative and postoperative 1st hour (p = 0.539), but at the postoperative 24th hour the MMSE scores were higher than both scores. In Group I, MMSE scores were similar at the preoperative and postoperative 24th hours (p = 0.116), whereas the postoperative 1st hour score was lower than both preoperative score (p = 0.006) and postoperative 24th hour score (p <0.001). In group I, the increase in postoperative serum NSE level was found to be statistically insignificant compared to the preoperative serum NSE level (p = 0.214). In group T, there was a statistically significant decrease in postoperative serum NSE level compared to preoperative serum NSE level (p = 0.038). There was no statistically significant relationship between MMSE scores at postoperative 1st and 24th hours and postoperative serum NSE levels in group T and group I. Conclusion: Administration of inhalation anesthesia may cause more cognitive dysfunction than the administration of TIVA at the first hour after surgery. The effects of both methods on cognitive functions were similar at 24 hours postoperatively. We think that the measurement of serum NSE level, which is one of the biomarkers used in the evaluation of cognitive functions, is insignificant to demonstrate POCD development, and studies with larger number of patients and with longer postoperative measurement times are needed.