Total intravenous anesthesia facilitates early cognitive recovery compared with inhalational anesthesia in Alzheimer's disease patients after cervical lymphatic-venous anastomosis: a randomized controlled trial

BACKGROUND: The optimal anesthesia method for Alzheimer's disease (AD) patients undergoing cervical lymphatic-venous anastomosis remains unclear. This study compared the effects of three general anesthesia techniques on postoperative cognitive outcomes in AD patients. METHODS: In this prospective randomized controlled trial, 132 AD patients were assigned (1:1:1) to receive total intravenous anesthesia (TIVA), total inhalation anesthesia (IH), or combined intravenous-inhalation anesthesia (CI). The primary outcome was cognitive function assessed by MMSE, MoCA and CDR at postoperative day 7 (P7), P90 and P180. The secondary outcome was ADL scores at P180. RESULTS: A total of 123 patients completed the study. At P7, MMSE scores in the TIVA group significantly improved from baseline (P < 0.05) and were superior to the IH and CI groups, which showed no significant change. At P90, MMSE scores improved in all three groups (P < 0.05), but returned to baseline by P180. No significant differences were observed in MoCA, CDR, or ADL scores at any time point. CONCLUSION: Among the three anesthesia methods, TIVA was associated with better early cognitive performance at P7 as measured by MMSE, compared with inhalational anesthesia. However, this benefit was not sustained to P180 and no significant changes were observed in MoCA or CDR scores at any time point. These findings suggest that TIVA may reduce early postoperative psychomotor disturbance rather than confer sustained neurocognitive recovery in this population.