St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia.
St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia.
Br J Anaesth. 2018 Nov;121(5):1005-1012. doi: 10.1016/j.bja.2017.11.087. Epub 2018 Jun 15.
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
麻醉和手术后影响患者认知能力的变化已经被认识超过 100 年了。20 世纪 80 年代，当多项研究使用详细的神经心理学测试来评估心脏手术后的认知变化时，对麻醉和手术后认知变化的研究加速了。这一系列的研究工作一致记录了老年患者在麻醉和手术后认知功能的下降，并且在手术后 7.5 年仍然可以识别出认知变化。重要的是，其他研究已经确定了非心脏手术后认知变化的发生率是相似的。除了纳入非手术对照组来计算手术后认知功能障碍外，在围手术期对这些认知变化的研究是与一般人群的认知研究分开进行的。这项工作的目的是开发类似于一般人群认知分类中使用的术语，用于研究麻醉和手术后的认知变化。一个多专业工作组采用了一种改良的 Delphi 程序，没有规定轮数，包括三次面对面会议，然后在线编辑草案版本。两个主要的分类指南[精神障碍诊断和统计手册，第五版（DSM-5）和国家老龄化研究所和阿尔茨海默病协会（NIA-AA）]在麻醉和手术之外使用，并且可能对纳入研究中的生物标志物有用。出于临床目的，建议使用 DSM-5 命名法。工作组建议将“围手术期神经认知障碍”用作术前或术后期间识别的认知障碍的总括术语。这包括在手术前诊断的认知下降（描述为神经认知障碍）；任何形式的急性事件（术后谵妄）和术后 30 天内诊断的认知下降（延迟性认知恢复）以及术后 12 个月（术后认知障碍）。
