Effects of Remifentanil Combined with Propofol on Perioperative Cognitive Dysfunction in Patients Undergoing Laparoscope-Assisted Radical Resection for Rectal Carcinoma

OBJECTIVE To explore the effects of remifentanil combined with propofol on perioperative cognitive dysfunction in patients undergoing laparoscope-assisted radical resection for rectal carcinoma. METHODS One hundred cases of rectal carcinoma patients undergoing laparoscope-assisted radical resection from January 2015 to January 2018 were selected as the objects. All of them were randomly divided into observation group and control group. The control group were received isoflurane and propofol. The observation group were given remifentanil combined with propofol intravenous anesthesia. The duration of anesthesia, recovery time, extubation time, intraoperative drug use and the number of cases of restlessness were compared between the two groups. The heart rate (HR) and mean arterial pressure (MAP) were recorded in two groups of patients with incision surgery (T1), operation start 60 min (T2), and at the end of the operation (T3). The neurological and psychiatric functions of preoperative and postoperative 3, 7 d patients were evaluated according to MMSE scale. The changes of amyloid β-protein(1-42) (Aβ-42), Tau protein and phosphorylated-Tau were compared between two groups, and the incidence of postoperative cognitive dysfunction (POCD) in two groups were recorded. RESULTS The recovery time, extubation time and the number of cases of restlessness in the observation group were significantly lower than those in control group(P<0.05). No difference was found on HR between the points of patients with incision surgery, operation start 60 min, and at the end of the operation in the control group. Compared with the point of patients with incision surgery, the HR had significantly decreased in T2, T3 in the observation group, the difference was statistically significant (P<0.05); compared with the control group, the HR of observation group were significantly lower than that in operation start 60 min, and at the end of the operation (P<0.05). The MMSE score in the observation group at 3, 7 d after operation were significantly higher than those in the control group, the difference was statistically significant(P<0.05), and the incidence of POCD in the observation group was significantly lower than that in the control group(P<0.05). Compared with preoperative anesthesia, the level of Tau protein and phosphorylated-Tau at 3, 7 d after operation were higher than before anesthesia, while the level of Aβ-42 protein had decreased and the Tau protein/Aβ-42 value increased (P<0.05), the Aβ-42 level in the observation group was higher than that in the control group, and the levels of Tau, phosphorylated-Tau and Tau/Ab-42 were lower than control group(P<0.05). CONCLUSION The implementation of remifentanil combined with propofol in the anesthesia of laparoscope-assisted radical resection for rectal carcinoma is effective. It can avoid the excessive increase of Tau protein and phosphorylated-Tau level and the excessive decrease of Aβ-42 level, improve cognitive function, and reduce the incidence of postoperative cognitive dysfunction.