Elderly patients undergoing pathophysiological changes necessitate clinical tools for cerebral monitoring. This prospective randomized controlled study aimed to explore how cerebral monitoring using Δo₂Hbi, ΔHHbi, and ΔcHbi manifests in elderly patients under either propofol or sevoflurane anesthesia.

Single-center, prospective, randomization.

A single tertiary hospital (Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea).

Enrolled 100 patients scheduled for urologic surgery under general anesthesia. Inclusion criteria were (a) age 70–80 years, (b) American Society of Anesthesiologists (ASA) physical status I-II.

Patients were double-blind randomized to receive propofol-based or sevoflurane anesthesia. Cerebral oximetry-related parameters were measured at 5, 10, 15, 20, and 30 min in a setting devoid of surgery-related factors.

The primary outcome focused on the Δo₂Hbi pattern in the left and right sides within the propofol and sevoflurane groups.

We analyzed 100 patients, 50 patients in each group. In the propofol group, the left Δo₂Hbi decreased from 1.4 (3.7) at 5 min to −0.1 (1.8) at 30 min (P < 0.0001), and the right Δo₂Hbi decreased from 2.9 (4.2) at 5 min to −0.06 (2.3) at 30 min (P < 0.0001). In the sevoflurane group, the left Δo₂Hbi decreased from 1.1 (3.4) at 5 min to −1.4 (4.4) at 30 min (P < 0.0001), and the right Δo₂Hbi decreased from 2.0 (3.2) at 5 min to −1.2 (3.9) at 30 min (P < 0.0001). There were no significant differences between the two groups. ΔHHbi did not exhibit significant changes after an initial decrease at 5 min and showed no significant differences between the two groups.

In cerebral oximetry, Δo₂Hbi and ΔHHbi could emerge as a valuable approach for discerning changes in the underlying baseline status of the brain in elderly patients during anesthesia.