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Preoperative cognitive impairment associated with oversedation during recovery from anesthesia

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Abstract

Purpose

Our objective was to examine the association between preoperative cognitive status and postoperative recovery from anesthesia.

Methods

We included patients (70–91 years old) from the Mayo Clinic Study of Aging who received general anesthesia and were admitted to the postanesthesia care unit from January 1, 2010 through April 30, 2018. Procedures were categorized according to patient’s preoperative cognitive status: cognitive impaired (CI) and cognitive unimpaired (CU). Perioperative records were reviewed and analyses were performed with generalized estimating equations.

Results

A total of 896 procedures from 611 patients were included, with 203 (22.7%) procedures in the CI group. Compared to CU procedures, CI procedures had higher rates of moderate–deep sedation during anesthesia recovery (52 [25.6%] vs. 103 [14.9%]; odds ratio [OR], 1.91; 95% CI, 1.30–2.80; P  < 0.01), postoperative pulmonary complications (22 [10.8%] vs. 34 [4.9%]; OR, 2.36[1.22–4.54]; P  =  0.01), and postoperative delirium (32 [16.2%] vs. 24 [3.5%]; OR, 5.33 [2.88–9.86]; P  <  0.01). When moderate–deep sedation during anesthesia recovery was a covariate, both CI (OR, 3.02[1.60–5.70]; P  <  0.01) and moderate–deep sedation (OR, 3.94[2.19–7.11]; P  <  0.01) were associated with delirium. In multivariable analysis, postoperative pulmonary complications were associated with moderate–deep sedation (OR, 2.14[1.18–3.87]; P  = 0 .01) but not with CI (OR, 1.49 [0.76–2.92]; P  = 0 .25).

Conclusions

Cognitive impairment was associated with higher rates of moderate–deep residual sedation during anesthesia recovery and delirium, while moderate–deep sedation was associated with higher rates of pulmonary complications and delirium. We speculate that tailoring the anesthetic to facilitate faster emergence for CI patients could improve complication rates.

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Abbreviations

CAM-ICU:

Confusion assessment method for the intensive care unit

CI:

Cognitive impaired

CU:

Cognitive unimpaired

ICU:

Intensive care unit

IQR:

Interquartile range

MCI:

Mild cognitive impairment

MCSA:

Mayo clinic study of aging

OR:

Odds ratio

PACU:

Postanesthesia care unit

PAINAD:

Pain assessment in advanced dementia

RASS:

Richmond agitation–sedation scale

STROBE:

Strengthening the reporting of observational studies in epidemiology

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Funding

This study was supported by NIH grants P50 AG016574 and U01 AG006786 (R.C.P), the Robert H. and Clarice Smith and Abigail van Buren Alzheimer’s Disease Research Program, the Rochester Epidemiology Project (R01 AG034676, principal investigators: Walter A. Rocca, MD, and Jennifer St. Sauver, PhD), and the Mayo Clinic Center for Translational Sciences Activities, grant No. UL1 TR000135 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Financial support for statistical analyses was provided by the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    S. Chandralekha Kruthiventi, Mariana L. Laporta, Atousa Deljou, David S. Knopman, Ronald C. Petersen, Darrell R. Schroeder, Juraj Sprung & Toby N. Weingarten

Authors
  1. S. Chandralekha Kruthiventi
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  2. Mariana L. Laporta
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  3. Atousa Deljou
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  4. David S. Knopman
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  5. Ronald C. Petersen
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  6. Darrell R. Schroeder
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  7. Juraj Sprung
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  8. Toby N. Weingarten
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Contributions

SCK, MLL, and AD collected, analyzed, and interpreted the data and helped to write the manuscript; DSK and RCP helped design the study and conducted revision for important intellectual content; DRS helped design the study, analyze the data, and conducted revision for important intellectual content; JS and TNW designed the study, analyzed and interpreted the data, and helped to write the manuscript.

Corresponding author

Correspondence to Toby N. Weingarten.

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Conflict of interest

D.S.K previously served as deputy editor for the journal Neurology, and he serves on a Data Safety Monitoring Board for Lundbeck and for the Dominantly Inherited Alzheimer Network Trials Unit. He is an investigator in clinical trials sponsored by Biogen, Eli Lilly and Co, University of Southern California, and TauRx Therapeutics Ltd, and he receives research support from the National Institutes of Health (NIH). R.C.P is the chair of Data Monitoring Committees for Pfizer Inc, GE Healthcare, and Janssen Alzheimer Immunotherapy, and he has served as a consultant for F. Hoffmann–La Roche AG; Biogen; Eisai Co, Ltd; Merck and Co, Inc; and Genentech, Inc. He receives royalties from sales of the book Mild Cognitive Impairment (Oxford University Press). T.N.W serves as a consultant to Medtronic in the role of chair of the Clinical Endpoint Committee for the Prodigy trial, and he has received research support (study equipment) from Respiratory Motion, Inc, and unrestricted investigator-initiated grants from Merck and Co, Inc, (completed) and Baxter International (completed). J.S, S.C.K, and M.L.L have nothing to disclose.

Ethical statement

In this retrospective study of elderly adults enrolled in the Mayo Clinic Study of Aging whose preoperative cognitive status was known, preoperative cognitive impairment was associated with moderate–deep sedation during anesthesia recovery. Both cognitive impairment and moderate–deep sedation were associated with postoperative delirium.

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Kruthiventi, S.C., Laporta, M.L., Deljou, A. et al. Preoperative cognitive impairment associated with oversedation during recovery from anesthesia. J Anesth 34, 390–396 (2020). https://doi.org/10.1007/s00540-020-02764-0

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  • DOI: https://doi.org/10.1007/s00540-020-02764-0

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