Supplementary Material

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Total intravenous anesthesia (TIVA) has a lower incidence of postoperative cognitive dysfunction (POCD) compared with inhalation agents in older patients undergoing non-cardiac surgery. This systematic review aimed to investigate the postoperative cognitive function in elderly patients following cardiac surgery with TIVA versus inhalation anesthesia. We searched the databases, Cochrane, MEDLINE, and EMBASE, up to May 2022 and selected relevant randomized controlled trials. For the metaanalysis, the random-effects model on the standardized mean difference for continuous outcomes and risk ratio for dichotomous outcomes were used. Five RCTs (590 participants) were included in the final analysis. The result showed that the cognitive score reduced  less after the operation in patients receiving volatile anesthesia compared with those receiving propofol-based TIVA, three days (SMD -2.31, 95% CI: [-4.63, 0.01], I2 = 96%, p < 0.01) and five days later (SMD -2.29, 95% CI: [-3.90, -0.68), I2 = 97%, p < 0.01). In contrast, The POCD five days after the operation did not lower significantly in patient receiving volatile anesthesia (RR 2.25, 95% CI: [0.51, 10.02], I2 = 61%, p = 0.11). Our findings indicated that for elderly patients undergoing elective cardiac surgery, the cognitive assessment score was reduced less with volatile anesthetics than with TIVA. The incidence of POCD was not significantly different. More studies to verify these results.