Cognitive function is minimally impaired after ambulatory surgery

Abstract

Purpose:To evaluate the magnitude of subjective cognitive failure in the three days following general anesthesia (GA) for ambulatory surgery. Methods:After Research Ethics Board approval, 258 patients undergoing general anesthesia (GA) and 250 patients scheduled for local anesthesia (LA) were recruited from our ambulatory surgical unit. Following the method of Tzabar, Asbury and Millar, patients were asked to complete the cognitive failures questionnaire (CFQ) before their procedure (with respect to the previous three days) and on the third postoperative day (with respect to their recovery period).Results: General anesthesia and LA groups were similar in demographic make-up, except that the LA group contained more patients of American Society of Anesthesiologists physical status I (64.5% vs 52.7%, P < 0.05) and had significantly shorter procedure duration (25 vs 51 min, P < 0.01) than the GA group. Median preoperative CFQ scores (interquartile range) were 26 (18) for the LA group and 26 (18) for the GA group. Postoperative CFQ scores were 25 (20) for the LA group and 28 (22) for the GA group. There was no significant difference in preoperative CFQ score between groups (Mann-Whitney U). When preoperative and postoperative CFQ scores were compared, the small increase seen in the GA group was statistically significant (P < 0.05, Wilcoxon). Conclusion:A statistically significant impairment of cognitive function in the three days following GA, but not LA was found. However, the magnitude of this impairment was small, and is of doubtful clinical significance. Modern ambulatory anesthesia may cause less delayed cognitive impairment than was previously thought. Objectif

Post-operative Quality of Recovery Scale: the impact of assessment method on cognitive recovery

“…There is no well‐established, gold standard for assessment of cognitive return after anaesthesia; thus, the PQRS cognitive domain needs to be further evaluated, compared with other tests, e.g. the cognitive failure questionnaire (CFQ) . Ward et al.…”

Day case and short stay surgery: 2

“…Mild postoperative confusion in the elderly after surgery is common. This is usually insignificant and should not influence discharge provided social circumstances permit; in fact, the avoidance of hospitalisation after minor surgery is preferred [15, 44]. Patients and their carers should be provided with written information that includes warning signs of possible complications and where to seek help.…”

Fonctions cognitives après anesthesie

“…Quant à une tâche plus complexe de conduite automobile sur simulateur, la performance est altérée pendant les 12-24 premières heures selon les études, chez des volontaires sains comme chez des patients ayant eu une anesthésie de très courte durée [7]. Enfin, lorsque les patients ayant eu une anesthésie ambulatoire de courte durée, sont interrogés a posteriori en utilisant un questionnaire systématique, ils signalent des erreurs cognitives commises quotidiennement dans les 3 jours suivants une anesthésie générale, erreurs absentes lorsque le geste a été pratiqué sous anesthésie locale [8].…”