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Swedish anaesthesiologists and nurse anaesthetists routines for evaluation and management of cognitive function: a nationwide survey
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden; CAMTÖ, Centre for Assessment of Medical Technology in Örebro, Sweden.
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(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Abstract [en]

Introduction: In clinical practice efforts have mainly been focused on cardiovascular and pulmonary risks, there is less attention on postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).

Methods: An online questionnaire regarding cognitive decline after anaesthesia and surgery was sent nationwide to a total of 2 626 anaesthesiologists and nurse anaesthetists. The questionnaire consisted of 3 parts, subjective preferences, routines and practices based on four typical case scenarios i.e. POCD, POD, emergence agitation (EA) and awareness.

Results: The response rate was n=417 (45%) and n=669 (55%) for anaesthesiologists and nurse anaesthetists respectively. Only 10% of the responders consider cognitive function, assessment of preoperatively and risk for cognitive side-effects postoperatively important. The concern regarding awareness was far greater (90%) than for EA, POD and POCD, 30- 45%. EEG based depth of anaesthetic monitoring (DOA) is used regularly by 10% and in 22% in patients with increased risk. Regarding treatment, investigation and follow-up routines, less than 15% had written structured protocols. Sixty percent of the respondents do not consider POCD as an important outcome. Anaesthesiologists have a better knowledge of screening methods, management and follow-up routines and drug treatment for POD, POCD and EA compared to nurse anaesthetists.

Conclusions: Our nationwide survey of anaesthesiologists and nurse anaesthetists shows that there is a general lack of knowledge about assessment and management of postoperative cognitive dysfunction. They are more concerned about awareness than the much more frequent and serious problems such as POD and POCD. In general DOA monitoring is not considered necessary. This survey shows that there is a clear need for improvement regarding knowledge of cognitive function.

Keywords [en]
Anaesthesia, Surgery, adverse effects; cognitive dysfunction, postoperative delirium, emergence agitation, POCD, depth of anaesthesia monitoring, AAI
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-34020OAI: oai:DiVA.org:oru-34020DiVA, id: diva2:700092
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
Open this publication in new window or tab >>Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients may suffer from various forms of postoperative cognitive dysfunction (POCD). In most cases, the impact on cognitive function is relatively transient but POCD can sometimes be long-lasting (> 1 year). Studies showing that up to one in four patients with known risk factors are affected by some form of cognitive loss. The cause of cognitive impairment after surgery and anaesthesia is still unclear. One hypothesis is that anaesthetic drugs may have an impact on the inflammatory process which occurs in conjunction to the tissue trauma caused by surgery. Titrating anaesthetic administration by the use of a depth of anaesthesia (DOA) monitors (AEP or BIS), usually reduce anaesthetic consumption and facilitate early recovery. In the initial two studies, the EEG-based DOA monitoring (AEP) was compared with a control group with standard monitoring for administration of anaesthesia. The AEP group required less anaesthetics and opioids and had faster early recovery but was also associated with a lower number of patients with < 25 MMSE score at 24-hours. We found in study III a relationship between the DOA and postoperative inflammatory response (IL-6). Patients with < 25 MMSE score had higher postoperative 24 hrs IL-6 levels. In the final study, we investigated the attitudes and knowledge among Swedish anaesthesiologists and nurse anaesthetists including the use of DOA, and to what extent written procedures regarding the pre-and postoperative cognitivedysfunction were used.

In conclusion, our studies show, the EEG-based guided DOA monitoring reduces consumption of anaesthetics and opioids during surgery, allows a faster postoperative recovery, and reduces the occurrence of cognitive impairment the first day after surgery and decrease inflammatory response after eye surgery. We found also an association between perioperative DOA, cognitive impairment and an increased inflammatory response after surgery. The interest and knowledge about assessment and management of neurocognitive side-effects before and after anaesthesia was found to be low among anaesthesiologists and nurse anaesthetists. They were critical about the benefits of the DOA monitoring. Swedish anaesthesiologists and nurse anaesthetists need to improve their knowledge of assessment and management of cognitive dysfunction.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 101
Keywords
Postoperative cognitive dysfunction, minor and major surgery, anaesthesia, depth of anaesthesia monitoring, auditory evoked potential, AAI, inflammatory marker
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32842 (URN)978-91-7668-987-5 (ISBN)
Public defence
2014-02-07, Hörsal C2, Campus USÖ, Universitetssjukhuset, S Grev Rosengatan, 701 85 Örebro, 08:45 (Swedish)
Opponent
Supervisors
Available from: 2014-01-23 Created: 2013-12-19 Last updated: 2017-10-17Bibliographically approved

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Jildenstål, PetherBerggren, Lars

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