A 2018 Cochrane review analyzing data from 869 participants out of an initial pool of 3,215 eligible patients provided low-certainty evidence that propofol-based Total Intravenous Anesthesia (TIVA) might reduce the incidence of postoperative cognitive dysfunction (POCD). The study reported an odds ratio of 0.52, with a 95% confidence interval ranging from 0.31 to 0.87. However, the reliability of this conclusion was limited by significant heterogeneity in research methodologies, highlighting the critical need for a standardized definition of POCD in future studies.
This conclusion is supported by earlier, smaller randomized controlled trials (RCTs) that compared the effects of propofol to sevoflurane. These studies observed that sevoflurane was associated with a higher incidence of POCD both 7 days and 9 months after surgery.
Additionally, this phenomenon might be connected to the use of EEG-guided anesthesia, which is frequently utilized alongside propofol during maintenance anesthesia. There is a substantial body of research investigating the benefits and mechanisms of EEG-guided anesthesia in minimizing cognitive impairments postoperatively.
