: Background Postoperative cognitive impairment after general anaesthesia, especially in the elderly, is a well-recognized problem. Xenon, known to be an N-methyl-d-aspartate antagonist, may be advantageous. In this study, the early cognitive function in the elderly after general anaesthesia with xenon was compared with that after desflurane. : Methods After approval by the local ethical committee and after obtaining written informed consent, patients were enrolled in this randomized, double-blinded, controlled study. Thirty-eight patients (65–75 yr old, ASA status I–III) undergoing an elective surgery with a planned duration of 60–180 min were allocated to either the xenon (n = 18) or the desflurane (n = 20) anaesthesia group. The primary outcome was the cognitive Test for Attentional Performance (TAP) with its subtests Alertness, Divided Attention, and Working Memory. After baseline assessment 12–24 h before operation, patients were followed-up 6–12 and 66–72 h after operation. Secondary outcomes were emergence times from anaesthesia and the modified Aldrete score. : Results No difference was found between the groups in the TAP at 6–12 and 66–72 h after operation. In the xenon group, emergence time was significantly faster for the following parameters: time to open eyes (P = 0.001), to react on demand (P = 0.001), to extubation (P = 0.001), and for time and spatial orientation (P = 0.007). The modified Aldrete score was significantly higher after 30, 45 and 60 min in the xenon group. : Conclusions There was no difference in the postoperative cognitive testing at 6–12 and 66–72 h. Xenon was associated in the elderly with a faster emergence from general anaesthesia than desflurane. [ABSTRACT FROM AUTHOR]