ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Effect of Sevoflurane Post-Conditioning on Postoperative Cognitive Function in Carotid Endarterectomy Patients :A Randomized, Double-Blind, Controlled Trial
Provisionally accepted
- 1Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, HangZhou, China
- 2The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- 3Zhejiang Provincial People's Hospital, Hangzhou, China
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Purpose: This study evaluated the effect of low-dose sevoflurane post-conditioning on early neurocognitive recovery in patients aged 50-80 years undergoing carotid endarterectomy (CEA). Methods: In this randomized, double-blind, single-center trial, 71 patients undergoing elective CEA receiving either sevoflurane post-conditioning (Group S, n=36) or standard propofol-based anesthesia (Group P, n=35) were analyszed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline, and on postoperative days 1 and 3. The primary outcome was the change in cognitive scores from baseline. Results: The two-way repeated-measures ANOVA revealed a significant main effect of group for both MMSE (P<0.001) and MoCA (P=0.019) scores. As the groups were comparable at baseline, this difference emerged postoperatively, driven by divergent outcomes on day 1: the propofol group (Group P) experienced a significant change in cognitive scores from baseline in both MMSE (-0.97 ± 1.81) and MoCA (-0.80 ± 1.83), whereas the scores in the sevoflurane group (Group S) were preserved in both MMSE (+0.58 ± 1.76) and MoCA (+0.81 ± 2.59). A significant between-group difference was therefore evident on postoperative day 1 (MMSE P=0.002; MoCA P=0.037) and was maintained on postoperative day 3 (MMSE P=0.023; MoCA P=0.036). Conclusion: Low-dose sevoflurane post-conditioning provides superior short-term preservation of cognitive function compared to standard anesthesia in patients undergoing CEA. These findings support the potential neuroprotective role of sevoflurane post-conditioning. Further research is warranted to explore long-term outcomes that incorporate biological sample testing.
Keywords: Cognition, sevoflurane, Carotid endarterectomy, neurocognitive recovery, Postoperative cognition, Anesthesia effects
Received: 30 Sep 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Wang, Li, Wang, Jin, Zhu, Sun and Lang. 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:
Bin Wang, wangbin2012@zju.edu.cn
Da wei Sun, sundaweide@163.com
Jun hui Lang, langjunhui@hmc.edu.cn
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