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Computerized tests to evaluate recovery of cognitive function after deep sedation with propofol and remifentanil for colonoscopy

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Abstract

The use of sedation for diagnostic procedures including gastrointestinal endoscopy is rapidly growing. Recovery of cognitive function after sedation is important because it would be important for most patients to resume safe, normal life soon after the procedure. Computerized tests have shown being accurate descriptors of cognitive function. The purpose of the present study was to evaluate the time course of cognitive function recovery after sedation with propofol and remifentanil. A prospective observational double blind clinical study conducted in 34 young healthy adults undergoing elective outpatient colonoscopy under sedation with the combination of propofol and remifentanil using a target controlled infusion system. Cognitive function was measured using a validated battery of computerized cognitive tests (Cogstate™, Melbourne, Australia) at different predefined times: prior to starting sedation (Tbaseline), and then 10 min (T10), 40 min (T40) and 120 min (T120) after the end of colonoscopy. Tests included the assessment of psychomotor function, attention, visual memory and working memory. All colonoscopies were completed (median time: 26 min) without significant adverse events. Patients received a median total dose of propofol and remifentanil of 149 mg and 98 µg, respectively. Psychomotor function and attention declined at T10 but were back to baseline values at T40 for all patients. The magnitude of psychomotor task reduction was large (d = 0.81) however 100% of patients were recovered at T40. Memory related tasks were not affected 10 min after ending sedation. Cognitive impairment in attention and psychomotor function after propofol and remifentanil sedation was significant and large and could be easily detected by computerized cognitive tests. Even though, patients were fully recovered 40 min after ending the procedure. From a cognitive recovery point of view, larger studies should be undertaken to propose adequate criteria for discharge after sedation.

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Authors and Affiliations

  1. Anesthesiology Department, Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain

    Xavier Borrat, Marta Ubre, Raquel Risco, Pedro L. Gambús, Jaume Balust & Graciela Martínez-Palli

  2. Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Barcelona, Spain

    Xavier Borrat, Pedro L. Gambús & Aina Iglesias

  3. Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), San Francisco, CA, USA

    Pedro L. Gambús

  4. Endoscopy Unit, ICMDiM, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Angela Pedroso, Gloria Fernandez-Esparrach, Àngels Ginés & Graciela Martínez-Palli

  5. Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Pedro L. Gambús, Gloria Fernandez-Esparrach & Àngels Ginés

  6. Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain

    Gloria Fernandez-Esparrach & Àngels Ginés

Authors
  1. Xavier Borrat
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  2. Marta Ubre
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  3. Raquel Risco
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  4. Pedro L. Gambús
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  5. Angela Pedroso
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  6. Aina Iglesias
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  7. Gloria Fernandez-Esparrach
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  8. Àngels Ginés
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  9. Jaume Balust
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  10. Graciela Martínez-Palli
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Correspondence to Xavier Borrat.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authorized by Agencia Española de Medicamentos y Productos Sanitarios (MAR-PRO-2010-01).

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Borrat, X., Ubre, M., Risco, R. et al. Computerized tests to evaluate recovery of cognitive function after deep sedation with propofol and remifentanil for colonoscopy. J Clin Monit Comput 33, 107–113 (2019). https://doi.org/10.1007/s10877-018-0134-3

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  • DOI: https://doi.org/10.1007/s10877-018-0134-3

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