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

  • Xavier Borrat
  • Marta Ubre
  • Raquel Risco
  • Pedro L. Gambús
  • Angela Pedroso
  • Aina Iglesias
  • Gloria Fernandez-Esparrach
  • Àngels Ginés
  • Jaume Balust
  • Graciela Martínez-Palli
Original Research
  • 87 Downloads

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.

Keywords

Cognitive recovery Sedation Remifentanil Propofol Endoscopy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

References

  1. 1.
    Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013;19:463–81.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Singh H, Poluha W, Cheung M, Choptain N, Baron KI, Taback SP. Propofol for sedation during colonoscopy. Cochrane database Syst Rev. 2008;4:CD006268.Google Scholar
  3. 3.
    Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol. 2000;95:1476–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Patki A, Shelgaonkar VC. A comparison of equisedative infusions of propofol and midazolam for conscious sedation during spinal anesthesia: a prospective randomized study. J Anaesthesiol Clin Pharmacol. 2011;27:47–53.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Moerman AT, Herregods LL, Vos MM, De, De Vos MM, Mortier EP, Struys MMRF. Manual versus target-controlled infusion remifentanil administration in spontaneously breathing patients. Anesth Analg. 2009;108:828–34.CrossRefPubMedGoogle Scholar
  6. 6.
    Apfelbaum JL, Silverstein JH, Chung FF, Connis RT, Fillmore RB, Hunt SE, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118:291–307.CrossRefPubMedGoogle Scholar
  7. 7.
    Dumonceau J-M, Riphaus A, Schreiber F, Vilmann P, Beilenhoff U, Aparicio JR, et al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline–Updated June 2015. Endosc Germ. 2015;47:1175–89.CrossRefGoogle Scholar
  8. 8.
    Collie A, Darekar A, Weissgerber G, Toh MK, Snyder PJ, Maruff P, et al. Cognitive testing in early-phase clinical trials: development of a rapid computerized test battery and application in a simulated phase I study. Contemp Clin Trials. 2007;28:391–400.CrossRefPubMedGoogle Scholar
  9. 9.
    Padmanabhan U, Leslie K, Eer AS, Maruff P, Silbert BS. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg. 2009;109:1448–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Schnider TW, Minto CF, Gambus PL, Andresen C, Goodale DB, Shafer SL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88:1170–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86:10–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Gambús PL, Jensen EW, Jospin M, Borrat X, Martínez Pallí G, Fernández-Candil J, et al. Modeling the effect of propofol and remifentanil combinations for sedation-analgesia in endoscopic procedures using an Adaptive Neuro Fuzzy Inference System (ANFIS). Anesth Analg. 2011;112:331–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924–34.PubMedGoogle Scholar
  14. 14.
    Collie A, Maruff P, Darby DG, McStephen M. The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. J Int Neuropsychol Soc. 2003;9:419–28.CrossRefPubMedGoogle Scholar
  15. 15.
    Dunlap W, Cortina J. Meta-analysis of experiments with matched groups or repeated measures designs. Psychol. Methods. 1996;1:170–7.Google Scholar
  16. 16.
    Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates; 1988.Google Scholar
  17. 17.
    Maruff P, Werth J, Giordani B, Caveney AF, Feltner D, Snyder PJ. A statistical approach for classifying change in cognitive function in individuals following pharmacologic challenge: an example with alprazolam. Psychopharmacology. 2006;186:7–17.CrossRefPubMedGoogle Scholar
  18. 18.
    Willey J, Vargo JJ, Connor JT, Dumot JA, Conwell DL, Zuccaro G. Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD. Gastrointest Endosc. 2002;56:810–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Falleti MG, Maruff P, Collie A, Darby DG, McStephen M. Qualitative similarities in cognitive impairment associated with 24 h of sustained wakefulness and a blood alcohol concentration of 0.05%. J Sleep Res. 2003;12:265–74.CrossRefPubMedGoogle Scholar
  20. 20.
    Chung F, Assmann N. Car accidents after ambulatory surgery in patients without an escort. Anesth Analg. 2008;106:817–20. (table of contents).CrossRefPubMedGoogle Scholar
  21. 21.
    Bo L-L, Bai Y, Bian J-J, Wen P-S, Li J-B, Deng X-M. Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: a meta-analysis. World J Gastroenterol United States. 2011;17:3538–43.CrossRefGoogle Scholar
  22. 22.
    McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc United States. 2008;67:910–23.CrossRefGoogle Scholar
  23. 23.
    Horiuchi A, Nakayama Y, Fujii H, Katsuyama Y, Ohmori S, Tanaka N. Psychomotor recovery and blood propofol level in colonoscopy when using propofol sedation. Gastrointest Endosc. 2012;75:506–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Dressler I, Fritzsche T, Cortina K, Pragst F, Spies C, Rundshagen I. Psychomotor dysfunction after remifentanil/propofol anaesthesia. Eur J Anaesthesiol. 2007;24:347–54.CrossRefPubMedGoogle Scholar
  25. 25.
    Riphaus A, Gstettenbauer T, Frenz MB, Wehrmann T. Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study. Endoscopy. 2006;38:677–83.CrossRefPubMedGoogle Scholar
  26. 26.
    O’Hare RA, Mirakhur RK, Reid JE, Breslin DS, Hayes A. Recovery from propofol anaesthesia supplemented with remifentanil. Br J Anaesth. 2001;86:361–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Martínez Palli G, Ubré M, Rivas E, Blasi A, Borrat X, Pujol R, et al. An established anesthesia team-care model: over 12000 cases in a digestive endoscopy unit. Rev Esp Anestesiol Reanim 2011:58:406–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Xavier Borrat
    • 1
    • 2
  • Marta Ubre
    • 1
  • Raquel Risco
    • 1
  • Pedro L. Gambús
    • 1
    • 2
    • 3
    • 5
  • Angela Pedroso
    • 4
  • Aina Iglesias
    • 2
  • Gloria Fernandez-Esparrach
    • 4
    • 5
    • 6
  • Àngels Ginés
    • 4
    • 5
    • 6
  • Jaume Balust
    • 1
  • Graciela Martínez-Palli
    • 1
    • 4
  1. 1.Anesthesiology DepartmentHospital ClínicBarcelonaSpain
  2. 2.Systems Pharmacology Effect Control & Modeling (SPEC-M) Research GroupBarcelonaSpain
  3. 3.Department of Anesthesia and Perioperative CareUniversity of California San Francisco (UCSF)San FranciscoUSA
  4. 4.Endoscopy Unit, ICMDiM, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
  5. 5.Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS)BarcelonaSpain
  6. 6.Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD)BarcelonaSpain

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