الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
Abstract
ognition is defined as the mental processes of perception,
memory and information processing. Cognitive
dysfunction is thus impairment of these processes.
Postoperative cognitive dysfunction (POCD) is characterized
by progressive hypomnesia, personality change or deterioration
in cognitive function after surgery. The incidence of POCD is
rising steadily in patients undergoing general anesthesia. Risk
factors for POCD, such as advancing age, the severity of
surgery, the duration of anesthesia, the occurrence of
complications, pre-existing cognitive impairments and the level
of education, have been determined. Age is the main risk factor
for POCD, and although it is well recognized that the incidence
of POCD is higher in the elderly particularly those undergoing
sevoflurane anesthesia, the mechanism is not fully understood.
There have been several reports that central nervous system
inflammation provoked by anesthesia and surgery plays an
important role in the pathogenesis of POCD. Serum levels of S-
100β protein increases significantly in patients had POCD.
Patients and Methods:
The study design was a prospective, double blind,
randomized, controlled trial. It was conducted at Ain Shams
University hospitals, after the approval of the ethical
C
Summary and Conclusion
67
committee. Informed consent was obtained from each
participant Patients. Fourty five patients aged between 60 and
70 years undergoing lower esophageal carcinoma or gastric
carcinoma resection was enrolled. Patients were randomly
assigned to one of three groups using sealed envelopes (n = 15)
as follows: A group receiving sevoflurane anesthesia (Group
S); a group receiving sevoflurane anesthesia after preoperative
treatment with methylprednisolone (group S +MP); and a
control group of patients receiving intravenous propofol
anesthesia (group C). Patients’ demographic and basic clinical
characteristics, fluid balance, blood loss, duration of surgery,
temperature, time taken for recovery of spontaneous breathing,
eye opening on command and time taken for extubation were
recorded. We recorded vital data at five perioperative time
points: on entering the operating room (T0); before tracheal
intubation (T1); before surgery (T2); immediately after surgery
(T3) and immediately after tracheal extubation (T4). Blood
specimens were collected from the patients 10 min before
anesthesia (Ta), third (Tb), and seventh (Tc) postoperative
days. The concentrations of S-100β protein was measured using
an ELISA kit according to the manufacturer’s instructions. The
MMSE and Montreal Cognitive Assessment (MoCA) were
used to assess cognitive function the day before surgery (Ta),
and on third (Tb), and seventh (Tc) postoperative days.
Summary and Conclusion
68
Results:
The MMSE and MoCA scores on the third (Tb) and
seventh (Tc) postoperative days were significantly lower in
group S than controls (P <0.05). The MMSE and MoCA scores
on the third and seventh postoperative days were significantly
higher in group S +MP than group S (P <0.05). The
concentration of plasma S-100β protein was significantly
higher in group S than group C and group S +MP at all
postoperative time points (P <0.05).
Conclusion:
We found that the incidence of POCD was higher in
patients undergoing sevoflurane anesthesia for major surgery
than those receiving an intravenous propofol regime, and lower
in elderly patients pro-treating with methylprednisolone