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. 2018 Aug 21;2018(8):CD012317. doi: 10.1002/14651858.CD012317.pub2

Geng 2017.

Methods RCT, parallel design, single‐centre
Participants Total number of randomized participants: 150
Inclusion criteria
  1. ASA II to III, ≥ 65 years of age, sufficient level of education to be capable of completing neuropsychological tests


Exclusion criteria
  1. History of allergy to anaesthetics

  2. Dialysis‐dependent renal failure

  3. Liver transaminase level < 1.5 times the normal value

  4. MMSE score ≤ 26

  5. Pre‐existing diagnosis of schizophrenia or dementia

  6. Recent stroke

  7. Known disorder affecting cognition

  8. Mental dysfunction

  9. History of cerebral surgery

  10. Severe anxiety

  11. Recent history of alcohol abuse

  12. History of chronic opioid or other psychotropic drug use


Type of surgery: laparoscopic cholecystectomy
Baseline characteristics
TIVA group
  1. Age: not reported

  2. Gender, M/F: 20/30

  3. ASA grade: ASA II: 35; ASA III: 15


Inhalational maintenance group (isoflurane)
  1. Age: not reported

  2. Gender, M/F: 18/32

  3. ASA grade: ASA II: 33; ASA III: 17


Inhalational maintenance group (sevoflurane)
  1. Age: not reported

  2. Gender, M/F: 22/28

  3. ASA grade: ASA II: 31; ASA III: 19


Country: China
Setting: hospital
Interventions TIVA group
Participants: n = 50; 0 losses
Induction details: 5 minutes of pre‐oxygenation, then midazolam 0.05 mg/kg, fentanyl 4 µg/kg, rocuronium 0.6 mg/kg. TCI 3.0 µg/kg propofol
Maintenance details: propofol with target concentration 2.5 µg/mL to 3.0 µg/mL. Remifentanil 0.2 µg/kg/min to 0.3 µg/kg/min. To maintain BIS 40 to 50
Other information: all patients given crystalloids as required. All patients were given flurbiprofen 100 mg and granisetron 3 mg at beginning of operation, and 0.25% ropivacaine via local infiltration for postoperative analgesia
Inhalational maintenance groups
Participants: n = 50; 0 losses
Induction details: 5 minutes of pre‐oxygenation, then midazolam 0.05 mg/kg, fentanyl 4 µg/kg, rocuronium 0.6 mg/kg. TCI 3.0 µg/kg propofol
Maintenance details: isoflurane 1.0 MAC to 1.5 MAC. Remifentanil 0.2 µg/kg/min to 0.3 µg/kg/min. To maintain BIS 40 to 50
Other information: fluids and analgesics same as TIVA group
Inhalational maintenance groups
Participants: n = 50; 0 losses
Induction details: 5 minutes of pre‐oxygenation, then midazolam 0.05 mg/kg, fentanyl 4 µg/kg, rocuronium 0.6 mg/kg. TCI 3.0 µg/kg propofol
Maintenance details: sevoflurane 1.0 MAC to 1.5 MAC. Remifentanil 0.2 µg/kg/min to 0.3 µg/kg/min. To maintain BIS 40 to 50
Other information: fluids and analgesics same as TIVA group
Outcomes
  1. POCD on postoperative day 1 and 3 (using MMSE, vision test, the Digit Symbol Substitution Test, the Cumulative test, digit span, forward and backward, Trail Making Test Part A, the RAVLT, Grooved Pegboard Test (dominant and non‐dominant hand)). POCD defined as decline > 20% in at least 2 tests compared to baseline

  2. Plasma concentrations or protein biomarkers of POCD

  3. Proinflammatory markers

  4. Duration of anaesthesia and emergence times

  5. Use of vasoconstrictors

  6. Hypotension (number of participants, number of episodes, and duration)

Notes Funding/declarations of interest: no funding and authors declare no conflicts of interest
Study dates: December 2010 to June 2011
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Use of a computer‐generated random number table
Allocation concealment (selection bias) Unclear risk No details
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not feasible to blind anaesthetists to intervention groups
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk A blinded anaesthetist evaluated cognitive scores
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No losses
Selective reporting (reporting bias) Unclear risk Retrospective clinical trials registration (ChiCTR‐OCC‐11001411). Not feasible to assess risk of selective reporting bias
Other bias Unclear risk Some differences in duration of anaesthesia, surgery times, and time to emergence from anaesthesia. We were not certain whether these differences were clinically significant. Also note that no ages were reported in baseline characteristics