Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018

DeKosky, Steven T.; Rasmussen, Lars S.; Berger, Miles; Eckenhoff, Roderic G.; Evered, Lisbeth; Ames, David; Bekker, Alex; Blacker, Deborah; Browndyke, Jeffrey N.; Crosby, Greg; Deiner, Stacie; Dijk, Diederik van; Eckenhoff, Maryellen F.; Eriksson, Lars; Galasko, Dougas; Hogan, Kirk; Inouye, Sharon K.; Knopman, David S.; Lyketsos, Constantine G.; Marcantonio, Edward R.; Maruff, Paul; Maze, Mervyn; Oh, Esther S.; Orser, Beverley A.; Ottens, Thomas H.; Price, Catherine C.; Rasmussen, Lars S.; Sachdev, Perminder S.; Schenning, Katie J.; Scott, David A.; Seiber, Frederick E.; Silbert, Brendan; Silverstein, Jeffrey T.; Steinmetz, Jacob; Terrando, Niccolò; Trzapacz, Paula; Whittington, Rob; Xie, Zhongcong

doi:10.1016/j.bja.2017.11.087

Cited by 467 publications

(258 citation statements)

References 20 publications

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“…Nomenclature that incorporates POD with more persistent cognitive problems coincident with surgery and general anaesthesia has been proposed. 50 Although our study is not large enough to draw definitive conclusions regarding pharmacological choices for particular surgeries that might influence PACU-D, some interesting insight can be developed. The univariable analysis revealed that propofol infusion was associated with increased odds of developing PACU-D. Interestingly, TIVA alone did not exhibit the same association.…”

Section: Discussionmentioning

confidence: 99%

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Hesse

Kreuzer

Hight

et al. 2019

British Journal of Anaesthesia

138

146

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Background: Postoperative delirium is associated with an increased risk of morbidity and mortality, especially in the elderly. Delirium in the postanaesthesia care unit (PACU) could predict adverse clinical outcomes. Methods: We investigated a potential link between intraoperative EEG patterns and PACU delirium as well as an association of PACU delirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACU delirium were also explored. Data were collected from 626 patients receiving general anaesthesia for procedures that would not interfere with frontal EEG recording. Results: Of the 626 subjects enrolled, 125 tested positive for PACU delirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACU delirium in the univariable analysis, the multivariable analysis revealed the importance of information derived from the EEG, anaesthetic technique, anaesthesia duration, and history of stroke or neurodegenerative disease. The occurrence of EEG burst suppression during maintenance [odds ratio (OR)¼1.86 (1.13e3.05)] and the type of EEG emergence trajectory may be predictive of PACU delirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACU delirium, especially in cases that involved ketamine or nitrous oxide [OR¼6.51 (3.00e14.12)]. Additionally, subjects with PACU delirium were at an increased risk for readmission [OR¼2.17 (1.13e4.17)] and twice as likely to stay >6 days in the hospital.Conclusions: Specific EEG patterns were associated with PACU delirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACU delirium and identify key areas of investigation for its prevention.

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Section: Discussionmentioning

confidence: 99%

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Hesse

Kreuzer

Hight

et al. 2019

British Journal of Anaesthesia

138

146

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“…In the new recommendations for the nomenclature of cognitive change associated with anesthesia and surgery-2018, however, it is required that definitions of POD must meet the diagnostic criteria of delirium in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. 2 Evidently, the use of Intensive Care Delirium Screening Checklist ≥3 points for definitions of POD in this study could not achieve the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders fifth edition for delirium. Actually, the intensive care unit delirium assessment tools are not adequately sensitive to identify POD in non-intensive care unit settings.…”

mentioning

confidence: 65%

Re: Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

2020

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In a multi-institutional prospective study, Matsuki et al. assessed incidence and risk factors of postoperative delirium (POD) in elderly patients undergoing urological surgery, and showed that a history of cerebrovascular disease, low Hasegawa Dementia Scale-Revised score and serum albumin level, and long surgery duration were independent risk factors for POD. 1 As POD has been significantly associated with increased length of hospital stay, costs, morbidity and mortality in patients undergoing urological surgery, their findings have potential clinical implications. However, we noted several issues in this study that were not well addressed.First, in this study, the POD that occurred within 7 days after surgery was defined by a criterion of Intensive Care Delirium Screening Checklist ≥3 points in accordance with the Japanese version of the Intensive Care Delirium Screening Checklist. In the new recommendations for the nomenclature of cognitive change associated with anesthesia and surgery-2018, however, it is required that definitions of POD must meet the diagnostic criteria of delirium in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. 2 Evidently, the use of Intensive Care Delirium Screening Checklist ≥3 points for definitions of POD in this study could not achieve the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders fifth edition for delirium. Actually, the intensive care unit delirium assessment tools are not adequately sensitive to identify POD in non-intensive care unit settings. We are concerned that the use of an improper criterion of definition in this study would have confounded diagnosis of POD.Second, by using a cut-off value of <3.5 g/dL (diagnostic criteria of hypoalbuminemia), a low serum albumin level was identified as an independent risk factor for POD. We noted that mean hemoglobin levels were 12.7 AE 1.8 and 13.2 AE 1.8 g/dL in patient with and without POD, with no significant difference. However, only comparing mean hemoglobin levels might have limited clinical values. The authors should report the incidence of preoperative anemia and assess the effect of preoperative anemia on the occurrence of POD. It must be emphasized that preoperative anemia is common among elderly surgical patients, and has been significantly associated with an increased risk of POD. In clinical practice, correction of both hypoalbuminemia and anemia before surgery has become one element of multicomponent prehabilitation programs reducing the occurrence of POD in elderly patients undergoing major surgery. 3 Third, only providing the type of anesthesia (general or spinal) was not enough when anesthetic interventions were taken as confounders for identifying potential risk factors of POD by multivariate analysis. Among drugs commonly used in anesthetic practice, opioids, sevoflurane, benzodiazepines and anticholinergics have been implicated in the development of POD. Other than great blood loss and transfusion provided in this study, furthermore, intraoperative hemo...

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“…An adverse outcome after surgery considered particularly relevant in (but not restricted to) the elderly is postoperative cognitive decline 5 . This deterioration in cognitive functioning following surgery has been termed as postoperative neurocognitive disorder (NCD) recently 6 …”

Section: Introductionmentioning

confidence: 99%

“…5 This deterioration in cognitive functioning following surgery has been termed as postoperative neurocognitive disorder (NCD) recently. 6 Although it has been reported that postoperative NCD is a multifactorial phenomenon, there are few well-established risk factors. 7 Accumulating evidence suggests that postoperative NCD might result from increased inflammatory activity.…”

mentioning

confidence: 99%

The association of preoperative anxiety and depression with neurocognitive disorder following oncological surgery

Absalom

Leeuwen

Bock

2020

Journal of Surgical Oncology

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Background The proposed underlying mechanisms of anxiety and depression, and of postoperative neurocognitive disorder (NCD), each include immune system involvement. Therefore, the aims of this study were to investigate the incidence of postoperative NCD 3 months after surgery among oncological patients undergoing surgery and to evaluate the role of preoperative anxiety and depression. Method A consecutive series of patients (age ≥ 18 years) undergoing surgery for the removal of solid tumors were included (n = 218). Cognitive performance was assessed preoperatively and at 3 months postoperatively. Preoperative anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. Results NCD affected 12.3% of elderly patients (age ≥ 70 years, n = 57) at 3 months after surgery, with executive function mostly affected. By contrast, 8.4% of younger patients (age < 70 years, n = 107) were affected, with information processing speed mostly affected. Low educational attainment was a risk factor (OR, 6.0; 95% CI, 1.9–19.0) of overall NCD, whereas preoperative anxiety was associated with decline in the domain of executive function. Conclusion Postoperative NCD is a complication of oncological surgery for all adults instead of the elderly only. Preoperative anxiety was associated with an increased risk of executive function decline, and low educational attainment was a key factor for overall NCD.

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Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018

Cited by 467 publications

References 20 publications

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Re: Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

The association of preoperative anxiety and depression with neurocognitive disorder following oncological surgery

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