{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T20:20:41Z","timestamp":1788121241676,"version":"build-2803163510"},"reference-count":25,"publisher":"Institute of Physiology of the Czech Academy of Sciences","issue":"Vol 72(2)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Physiol Res"],"published-print":{"date-parts":[[2023,4,30]]},"abstract":"<jats:p>Increased incidence of postoperative cognitive dysfunction (POCD) is observed in elderly patients underwent intravenous anesthesia (TIVA) with endotracheal intubation. Modulation of anesthetics compatibility may reduce the severity of POCD. Elderly patients scheduled for TIVA with endotracheal intubation were randomly divided into the control group (1.00\u20112.00 mg\/kg propofol) and the etomidate and propofol combination group (1.00\u20112.00 mg\/kg propofol and 0.30 mg\/kg etomidate). Serum cortisol, S100\u03b2, and neuron-specific enolase (NSE), interleukin (IL)-6, and IL-10 were monitored during or after the operation. Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were utilized to assess the severity of POCD. 63 elderly patients in the etomidate and propofol combination group and 60 patients in the control group were enrolled, and there was no significant difference in gender, American Society of Anesthesiologists (ASA) physical status, surgical specialty, intraoperative blood loss, and operation time between the two groups. Significantly increased serum cortisol, S100\u03b2, NSE, IL-6, and reduced MMSE and MoCA scores were detected in the control group at different time points after the operation (0-72 h post operation) when compared to those before the operation. Similar trends for these observed factors were found in the etomidate and propofol combination group. In addition, the etomidate and propofol combination group showed better effects in reducing the serum levels of cortisol, S100\u03b2, NSE, IL-6, and increasing the MMSE and MoCA scores when compared to the control group. The present study demonstrates that the combination of propofol with etomidate could alleviate POCD in elderly patients underwent TIVA with endotracheal intubation anesthesia.<\/jats:p>","DOI":"10.33549\/physiolres.934983","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T10:38:45Z","timestamp":1683196725000},"page":"251-258","source":"Crossref","is-referenced-by-count":13,"title":["Effects of total intravenous anesthesia with etomidate and propofol on postoperative cognitive dysfunction"],"prefix":"10.33549","author":[{"given":"Y","family":"Zhi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Jiangnan University Medical Center, JUMC, Wuxi, Jiangsu Province, China. liwenjing20032004@126.com"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19169","reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Cole CD, Gottfried ON, Gupta DK, Couldwell WT. Total intravenous anesthesia: advantages for intracranial surgery. Neurosurgery 2007;61:369-377; discussion 377-368. https:\/\/doi.org\/10.1227\/01.neu.0000303996.74526.30","DOI":"10.1227\/01.neu.0000303996.74526.30"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Lin X, Chen Y, Zhang P, Chen G, Zhou Y, Yu X. The potential mechanism of postoperative cognitive dysfunction in older people. Exp Gerontol 2020;130:110791. https:\/\/doi.org\/10.1016\/j.exger.2019.110791","DOI":"10.1016\/j.exger.2019.110791"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Lan X, Yang D, Xie S, Zhao Z. Effects of full inhalation of sevoflurane and total intravenous anesthesia on hemodynamics, serum myocardial enzymes, and myocardial markers in elderly patients undergoing hysterectomy. BioMed Res Int 2021;2021:9983988. https:\/\/doi.org\/10.1155\/2021\/9983988","DOI":"10.1155\/2021\/9983988"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Liu Y, Su M, Li W, Yuan H, Yang C. Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study. BMC Anesthesiol 2019;19:230. https:\/\/doi.org\/10.1186\/s12871-019-0908-2","DOI":"10.1186\/s12871-019-0908-2"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Gong M, Wang G, Li G, Liu J, Sun P, Xu L, Li J, Guo Y, Zhang M. Dysfunction of inflammation-resolving pathways is associated with postoperative cognitive decline in elderly mice. Behav Brain Res 2020;386:112538. https:\/\/doi.org\/10.1016\/j.bbr.2020.112538","DOI":"10.1016\/j.bbr.2020.112538"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol 2015;15:154. https:\/\/doi.org\/10.1186\/s12871-015-0130-9","DOI":"10.1186\/s12871-015-0130-9"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Edalatkhah A, Kazemi MR, Samadi Khorshidi F, Akhoundimeybodi Z, Seyedhosseini SM, Rostami S, Hosseini BV, Akhondi Z, Ghelmani Y. Comparison of the effects of etomidate, ketamine, sodium thiopental, and midazolam on the mortality of patients with COVID-19 requiring intubation. Med J Islam Repub Iran 2021;35:49. https:\/\/doi.org\/10.47176\/mjiri.35.49","DOI":"10.47176\/mjiri.35.49"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Pacheco GS, Ferayorni A. Pediatric procedural sedation and analgesia. Emerg Med Clin North Am. 013;31:831-852. https:\/\/doi.org\/10.1016\/j.emc.2013.04.002","DOI":"10.1016\/j.emc.2013.04.002"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Valk BI, Struys M. Etomidate and its Analogs: A Review of Pharmacokinetics and Pharmacodynamics. Clin Pharmacokinet 2021;60:1253-1269. https:\/\/doi.org\/10.1007\/s40262-021-01038-6","DOI":"10.1007\/s40262-021-01038-6"},{"key":"ref9","unstructured":"Williams LM, Boyd KL, Fitzgerald BM. Etomidate. In: StatPearls. Treasure Island (FL): StatPearls Publishing; Last Update: February 19, 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535364\/"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Folstein MF, Folstein SE, McHugh PR. \"Mini-mental state\". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198. https:\/\/doi.org\/10.1016\/0022-3956(75)90026-6","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Nasreddine ZS, Phillips NA, B\u00e9dirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-699. https:\/\/doi.org\/10.1111\/j.1532-5415.2005.53221.x","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Abdallah SI, Gaballah KM. Endotracheal intubation criteria and stress response: airtraq versus macintosh laryngoscopes - a prospective randomized controlled trial. Anesth Essays Res 2019;13:430-436. https:\/\/doi.org\/10.4103\/aer.AER_80_19","DOI":"10.4103\/aer.aer_80_19"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Wan Z, Li Y, Ye H, Zi Y, Zhang G, Wang X. Plasma S100\u03b2 and neuron-specific enolase, but not neuroglobin, are associated with early cognitive dysfunction after total arch replacement surgery: A pilot study. 2021;100:e25446. https:\/\/doi.org\/10.1097\/MD.0000000000025446","DOI":"10.1097\/md.0000000000025446"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Silva F, Schmidt A, Valentin L, Osternack-Pinto K, Zeferino S, Oses J, Wiener C, Otsuki D, Tort L, Portela L, Souza D, Auler J, Carmona M. S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery. Eur J Anaesthesiol 2016;33:1. https:\/\/doi.org\/10.1097\/EJA.0000000000000450","DOI":"10.1097\/eja.0000000000000450"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Wennberg AMV, Hagen CE, Machulda MM, Knopman DS, Petersen RC, Mielke MM. The cross-sectional and longitudinal associations between IL-6, IL-10, and TNF\u03b1 and cognitive outcomes in the Mayo Clinic study of aging. J Gerontol A Biol Sci Med Sci 2019;74:1289-1295. https:\/\/doi.org\/10.1093\/gerona\/gly217","DOI":"10.1093\/gerona\/gly217"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Sanders RD, Pandharipande PP, Davidson AJ, Ma D, Maze M. Anticipating and managing postoperative delirium and cognitive decline in adults. Bmj 2011;343:d4331. https:\/\/doi.org\/10.1136\/bmj.d4331","DOI":"10.1136\/bmj.d4331"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"H OB, Mohan H, Hare CO, Reynolds JV, Kenny RA. Mind Over Matter? The Hidden Epidemic of Cognitive Dysfunction in the Older Surgical Patient. Ann Surg 2017;265:677-691. https:\/\/doi.org\/10.1097\/SLA.0000000000001900","DOI":"10.1097\/sla.0000000000001900"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Lili X, Zhiyong H, Jianjun S. A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery. Neurosci Lett 2013;541:15-19. https:\/\/doi.org\/10.1016\/j.neulet.2013.02.008","DOI":"10.1016\/j.neulet.2013.02.008"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Li YC, Xi CH, An YF, Dong WH, Zhou M. Perioperative inflammatory response and protein S-100\u03b2 concentrations - relationship with post-operative cognitive dysfunction in elderly patients. Acta Anaesthesiol Scand 2012;56:595-600. https:\/\/doi.org\/10.1111\/j.1399-6576.2011.02616.x","DOI":"10.1111\/j.1399-6576.2011.02616.x"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Heizmann CW, Fritz G, Sch\u00e4fer BW. S100 proteins: structure, functions and pathology. Front Biosci 2002;7:d1356-1368. https:\/\/doi.org\/10.2741\/A846","DOI":"10.2741\/a846"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Erdem AF, Sahin YN, Dogan N, Umudum Z, Bayar F, Bulut C, Alici HA, Erkut B, Cesur M, Ceviz M. Effects of sevoflurane and propofol on S100\u03b2 and neuron-specific enolase protein levels during cardiopulmonary bypass. Niger J Clin Pract 2016;19:278-283. https:\/\/doi.org\/10.4103\/1119-3077.164346","DOI":"10.4103\/1119-3077.164346"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Hudson AE, Hemmings HC: 3 - Pharmacokinetics of Inhaled Anesthetics; in (Hemmings HC, and Egan TD, eds) Pharmacology and Physiology for Anesthesia (Second Edition). Philadelphia, Elsevier, 2019, vol. https:\/\/doi.org\/10.1016\/B978-0-323-48110-6.00003-Xp. pp.44-69. https:\/\/doi.org\/10.1016\/B978-0-323-48110-6.00003-X","DOI":"10.1016\/b978-0-323-48110-6.00003-x"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Hartle AJ, Peel PH. Etomidate puts patients at risk of adrenal crisis. Bmj 2012;345:e7444. https:\/\/doi.org\/10.1136\/bmj.e7444","DOI":"10.1136\/bmj.e7444"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Xie D, Li M, Yu K, Lu H, Chen Y. Etomidate alleviates cardiac dysfunction, fibrosis and oxidative stress in rats with myocardial ischemic reperfusion injury. Ann Transl Med 2020;8:1181. https:\/\/doi.org\/10.21037\/atm-20-6015","DOI":"10.21037\/atm-20-6015"}],"container-title":["Physiological Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T10:39:07Z","timestamp":1683196747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.biomed.cas.cz\/physiolres\/pdf\/2023\/72_251.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,30]]},"references-count":25,"journal-issue":{"issue":"Vol 72(2)","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.33549\/physiolres.934983","relation":{},"ISSN":["1802-9973","0862-8408"],"issn-type":[{"value":"1802-9973","type":"electronic"},{"value":"0862-8408","type":"print"}],"subject":[],"published":{"date-parts":[[2023,4,30]]}}}