Canadian Journal of Anesthesia

, 52:1017 | Cite as

Cognitive function is minimally impaired after ambulatory surgery

  • Barnaby Ward
  • Charles Imarengiaye
  • Javad Peirovy
  • Frances Chung
General Anesthesia



To evaluate the magnitude of subjective cognitive failure in the three days following general anesthesia (GA) for ambulatory surgery.


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).


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).


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.


Sevoflurane Local Anesthesia Desflurane Anesthetic Technique Cognitive Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La fonction cognitive est peu altérée après une intervention chirurgicale ambulatoire



Évaluer ľimportance de ľatteinte cognitive subjective au cours des trois jours suivant ľanesthésie générale (AG) pour une opération en chirurgie ambulatoire.


Le Comité ďéthique de la recherche ayant donné son accord, 258 patients devant subir une AG et 250 patients, une anesthésie locale (AL), ont été recrutés en chirurgie ambulatoire. Nous avons utilisé la méthode de Tzabar, Asbury et Millar et demandé aux patients de remplir le questionnaire sur les défaillances cognitives (QDC) avant leur opération (concernant les trois jours précédant ľopération) et le 3e jour postopératoire (selon la période de récupération).


La composition démographique des groupes AG et AL a été similaire, sauf que le groupe AL comptait plus de patients ďétat physique I ASA (64,5 % vs 52,7 %, P < 0,05) qui ont subi une opération significativement plus courte en moyenne (25 vs 51 min, P < 0,01) que ceux du groupe AG. Les scores préopératoires médians au QDC (intervalle interquartile) ont été de 26 (18) pour le groupe AL et de 26 (18) pour le groupe AG. Les scores post-opératoires ont été de 25 (20) pour le groupe AL et de 28 (22) pour le groupe AG. Il n’y a pas eu de différence significative de score préopératoire entre les groupes (test U de Mann-Whitney U). En comparant les scores préopératoires et postopératoires, on découvre une petite augmentation qui est statistiquement significative dans le groupe AG (P < 0,05, Wilcoxon).


Une atteinte statistiquement significative de la fonction cognitive a été trouvée pendant les trois jours qui ont suivi ľintervention chirurgicale sous AG mais non sous AL. Ľimportance de cette atteinte est toutefois minime et peu significative cliniquement. Ľanesthésie ambulatoire moderne cause moins ďatteinte cognitive différée qu’on ne ľavait ďabord cru.


  1. 1.
    Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg 2004; 98: 632–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogg TW, Fischer HB, Bethune DW, Collis JM. Day case anaesthesia and memory. Anaesthesia 1979; 34: 784–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Edwards H, Rose EA, Schorow M, King TC. Postoperative deterioration in psychomotor function. JAMA 1981; 245: 1342–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Herbert M, Healy TE, Bourke JB, Fletcher IR, Rose JM. Profile of recovery after general anaesthesia. Br Med J 1983; 286: 1539–42.Google Scholar
  5. 5.
    Chung F, Seyone C, Dyck B, et al. Age-related cognitive recovery after general anesthesia. Anesth Analg 1990; 71: 217–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol 1982; 21: 1–16.PubMedGoogle Scholar
  7. 7.
    Wagle AC, Berrios GE, Ho L. The cognitive failures questionnaire in psychiatry. Compr Psychiatry 1999; 40: 478–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Mahoney AM, Dalby JT, King MC. Cognitive failures and stress. Psychol Rep 1998; 82: 1432–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Pollina LK, Greene AL, Tunick RH, Puckett JM. Dimensions of everyday memory in adulthood. Br J Psychol 1992; 83: 305–21.PubMedGoogle Scholar
  10. 10.
    van Gorp WG, Satz P, Hinkin C, et. al. Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance. J Clin Exp Neuropsychol 1991; 13: 812–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Tzabar Y, Asbury AJ, Millar K. Cognitive failures after general anaesthesia for day-case surgery. Br J Anaesth 1996; 76: 194–7.PubMedGoogle Scholar
  12. 12.
    Chen X, Zhao M, White PF, et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg 2001; 93: 1489–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Pollard BJ, Bryan A, Bennett D, et al. Recovery after oral surgery with halothane, enflurane, isoflurane or propofol anaesthesia. Br J Anaesth 1994; 72: 559–66.PubMedCrossRefGoogle Scholar
  14. 14.
    Sanou J, Goodall G, Capuron L, Bourdalle-Badie C, Maurette P. Cognitive sequelae of propofol anaesthesia. Neuroreport 1996; 7: 1130–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Canet J, Raeder J, Rasmussen LS, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003; 47: 1204–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Sinclair DR, Chung F, Smiley A. General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period — a pilot study. Can J Anesth 2003; 50: 238–45.PubMedCrossRefGoogle Scholar
  17. 17.
    Edward R, Chung F, Kayumov L, Sinclair DR, Moller HJ, Shapiro CM. Driving impairment following ambulatory surgery. Can J Anesth 2004; 51: A71 (abstract).Google Scholar

Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Barnaby Ward
    • 1
  • Charles Imarengiaye
    • 1
  • Javad Peirovy
    • 1
  • Frances Chung
    • 1
  1. 1.Department of AnesthesiaToronto Western Hospital, University Health NetworkTorontoCanada

Personalised recommendations