Fathurrahman, Faishal Arif and Maulydia, M. and Airlangga, Prananda Surya and Waloejo, Christrijogo Sumartono and Salinding, Agustina (2026) Sevofluraneâ-Dexmedetomidine versus Propofol-based TIVA for Controlled Hypotension in Functional Endoscopic Sinus Surgery: Effects on Postoperative Cognitive Dysfunction. International Journal of Drug Delivery Technology, 16 (5). 510 - 517.

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Abstract

Background: Functional Endoscopic Sinus Surgery (FESS) often requires controlled hypotension to improve surgical visualization, which may increase the risk of postoperative cognitive dysfunction (POCD). Anesthetic agents differ in their neuroinflammatory and neuroprotective effects, potentially influencing POCD risk. Objective: This study aims to compare the incidence of POCD between Sevofluraneâ-Dexmedetomidine (DEX-S) anesthesia and Propofol-based total intravenous anesthesia (PRO) in FESS patients undergoing controlled hypotension. Methods: A prospective study was conducted on 32 adults (18â��65 years) undergoing elective FESS. Patients were assigned to DEX-S or PRO groups. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) preoperatively and at 24 and 72 hours after surgery. Perioperative hemodynamics, anesthesia duration, and blood loss were recorded. Statistical comparisons were made to evaluate cognitive outcomes and determine factors associated with POCD. Results: Both groups demonstrated a significant MMSE decline at 24 hours, followed by recovery at 72 hours. The DEX-S group showed a greater early decline than the PRO group (p < 0.05), but the overall incidence of POCD remained low and did not differ significantly between groups at either postoperative interval (p > 0.05). Higher age and lower educational level were identified as stronger predictors of POCD than anesthetic technique or intraoperative parameters. Conclusion: Sevofluraneâ��Dexmedetomidine and Propofol-based TIVA yield comparable effects on early postoperative cognitive function in FESS under controlled hypotension. Although DEX-S produced a greater transient cognitive decline, it did not increase POCD incidence. Patient characteristicsâ��particularly age and educationâ��play a more significant role in POCD development. © 2026, Dr. Yashwant Research Labs Pvt. Ltd.All rights reserved.

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