Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis

Cuninghame, Sean; Jerath, Angela; Gorsky, Kevin; Sivajohan, Asaanth; Francoeur, Conall; Withington, Davinia; Burry, Lisa; Cuthbertson, Brian H.; Orser, Beverley A.; Martin, Claudio; Owen, Adrian M.; Slessarev, Marat; Chapman, Martin; Scales, Damon; Nardi, Julie; Linseman, Beth; Lau, Phil; Yakubov, Boris; Carrier, François M.; Charbonney, Emmanuel; Chassé, Michaël; Girard, Martin; Halwagi, Antoine; Plourde, Guillaume; Wang, Han T.; Lafrance, Dominique; Corsilli, Danielle; Sokoloff, Catalina; D'Aragon, Frédérick; Tissot-Therrien, Maxime; Lamontagne, François; Bérard, Dominique; Cavayas, Yiorgos A.; Albert, Martin; Bernard, Francis; Serri, Karim; Williamson, David; Williams, Virginie; Barrios, Patricia M.; De Franca, Sabrina A.; Couture, Etienne J.; Côté, Adreanne; Simon, Mathieu; Lépine, Pierre-Alexis; Gleeton, Dave; Basmaji, John; Slessarev, Marat; Hegazy, Ahmed; Bentall, Tracey; Campbell, Eileen; Stephens, Michelle; Winterburn, Tim; Hatzakorzian, Roupen; Khwaja, Kosar; Goldberg, Peter; Shahin, Jason; Grushka, Jeremy R.; Hooper, Jonathan; Microys, Sherissa; Meggison, Hilary; Leilipovitz, David; Haines, Jessica; Watpool, Irene; Porteous, Rebecca; Dunster, Stephanie; Bourbonnais, Sylvie; Goligher, Ewan; Del Sorbo, Lorenzo; Ferguson, Niall; Graham, Philip; Long, Michael; Yan, Tina; Morris, Denise; Kobylecky, Maria; Abdelhady, Hesham; Romagnuolo, Tina; Randall, Ian; Wilcox, Elizabeth; Jacka, Michael; Rewa, Oleksa; Lau, Vincent; Bagshaw, Sean; Baig, Nadia

doi:10.1016/j.bja.2023.05.004

Cited by 7 publications

(4 citation statements)

References 55 publications

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“…This is a rare complication, particularly of sevoflurane use through the potential lowering of renal aquaporin-2 receptors that help to concentrate urine ( 24 , 25 ). Evidence examining the neurocognitive and long-term effects of ICU volatile use is limited, but current data show equivalent effects on ICU delirium ( 22 , 26 ).…”

Section: Discussionmentioning

confidence: 97%

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Gorsky,

Cuninghame,

Jayaraj

et al. 2024

Critical Care Explorations

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OBJECTIVES: Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. STUDY SELECTION: Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021. DATA EXTRACTION: Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials. DATA SYNTHESIS: Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol. CONCLUSIONS: Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.

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Section: Discussionmentioning

confidence: 97%

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Gorsky,

Cuninghame,

Jayaraj

et al. 2024

Critical Care Explorations

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“…These results corroborate the limited prior evidence suggesting increased anesthetic sensitivity in patients with cognitive impairment and dementia ( Eckenhoff et al, 2004 ; Bokeriia et al, 2006 ; Palop and Mucke, 2010 ; Ye et al, 2013 ). Mild cognitive impairment represents an intermediate transitional state along the continuum from normal aging to dementia, characterized by similar but less severe neuropathological changes such as cortical atrophy, neuronal degeneration, neurofibrillary tangles, amyloid plaque deposition, and synaptic receptor alterations ( Cuninghame et al, 2023 ). The observed increased propofol sensitivity in our cognitively impaired elderly cohort aligns with reports of lower anesthetic requirements for induction of unconsciousness, prolonged emergence times, and exaggerated EEG suppression in patients with dementia ( Pal et al, 2015 ; Purdon et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study

Zhuge,

Zhou,

Qiu

et al. 2024

Front. Aging Neurosci.

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BackgroundCognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients.MethodsSixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA <26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55–65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed.ResultsBIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, p = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, p = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups.ConclusionCompared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly.

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“…This study highlights the increasing recognition of the importance of comprehensive post-ICU care interventions in addressing the various challenges associated with PICS, such as cognitive impairment. In addition, a comprehensive analysis and synthesis of multiple studies was performed to assess the impact of inhaled anesthetics on cognitive function in critically ill people [ 30 ]. This study emphasizes the significance of taking into account sedation methods in order to reduce cognitive loss associated with PICS.…”

Section: Reviewmentioning

confidence: 99%

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

Ekong,

Monga,

Daher

et al. 2024

Cureus

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Post-intensive care syndrome (PICS) is the term used to describe the decline in the physical, cognitive, and/or mental condition of individuals who have been discharged from the intensive care unit (ICU). This complication could result in a significant reduction in quality of life, with some patients experiencing symptoms of prolonged weakness, depression, anxiety, and post-traumatic stress disorder (PTSD). Intensive care advancement over the years has resulted in an increase in ICU survival rates and a proportional increase in PICS, creating a need for more in-depth research into the prevention and management of the disease. Hence, this study aims to examine the present body of literature on PICS, encompassing its underlying physiological processes and elements that contribute to its development, methods for evaluating and diagnosing the condition, current treatment choices as well as potential new approaches, and the constraints in managing PICS and the necessity for further investigation. In this article, studies were compiled from several databases, including, but not limited to, Google Scholar, PubMed, and Cochrane Library. These studies were reviewed, and their data were used to highlight important aspects regarding the efficacy of current PICS screening tools, the optimization and limitations of both pharmacologic and nonpharmacologic treatment methods, and the feasibility and safety of emerging treatments and technologies. The major conclusions of this review were centered around the need for multidisciplinary management of PICS. From pharmacological management using analgesia to non-pharmacological management using early mobilization and exercise therapy, the effective treatment of PICS requires a multifaceted approach. Patient follow-up and its importance were touched upon, including strategies and policies to bolster proper followup, thereby increasing favorable outcomes. Lastly, the importance of family involvement and the increased need for research into this topic were highlighted.

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Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis

Cited by 7 publications

References 55 publications

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Potential increased propofol sensitivity in cognitively impaired elderly: a controlled, double-blind study

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

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