ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Association between End-tidal Sevoflurane Concentration and Postoperative Cognitive Dysfunction and Pain Sensitivity in Elderly Patients under General Anesthesia
Provisionally accepted
- Third Affiliated Hospital of Anhui Medical University, Hefei, China
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Objective: To analyze the association between end-tidal sevoflurane concentration and postoperative cognitive dysfunction (POCD) and pain sensitivity in elderly patients under general anesthesia. Methods: A total of 121 elderly patients undergoing abdominal surgery were enrolled and divided into a low-concentration group (0.8–1.2 MAC, n=61) and a high-concentration group (1.5–2.0 MAC, n=60). End-tidal sevoflurane concentration, recovery parameters, Mini-Mental State Examination (MMSE) scores, POCD incidence, pain sensitivity (PSQ score, mechanical hypersensitivity areas and thresholds), and serum levels of neurological markers (NSE, ApoJ, NGF) and pain mediators (PGE2, 5-HT) were compared between groups. Pearson correlation and multivariate logistic regression were used to assess associations and influencing factors for POCD. Results: The high-concentration group had longer recovery times but a lower incidence of POCD (10.00% vs. 24.59%) and higher MMSE scores on postoperative days 1 and 3 (P<0.05). Pain sensitivity measures were reduced in the high-concentration group on postoperative day 1, with lower PSQ scores, smaller mechanical hypersensitivity areas, and higher mechanical thresholds (P<0.05). Compared to the low-concentration group, the high-concentration group exhibited significantly lower postoperative levels of NSE, ApoJ, PGE2, and 5-HT, and higher NGF levels (P<0.05). End-tidal sevoflurane concentration positively correlated with MMSE scores, mechanical thresholds, and NGF levels, and negatively correlated with pain sensitivity measures, NSE, ApoJ, PGE2, and 5-HT (P<0.05). Multivariate analysis identified age and preoperative elevations of NSE, ApoJ, PGE2, and 5-HT as risk factors for POCD, while higher sevoflurane concentration and preoperative NGF levels were protective factors (P<0.05). Conclusion: Higher end-tidal sevoflurane concentration is associated with improved postoperative cognitive function and reduced pain sensitivity in elderly patients, likely mediated by the modulation of neurological and pain-related biomarkers, serving as a protective factor against POCD.
Keywords: Cognitive Function, Elderly, general anesthesia, pain sensitivity, Sevoflurane Concentration
Received: 05 Dec 2025; Accepted: 20 Jan 2026.
Copyright: © 2026 Zhou, Zheng, Li, Wang, Zhang, Zheng, Luo and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hong Luo
Heng Yang
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