From the Nash Family Department of Neuroscience.
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Anesth Analg. 2022 Feb 1;134(2):389-399. doi: 10.1213/ANE.0000000000005824.
Postoperative delirium and postoperative cognitive dysfunction are the most common complications for older surgical patients. General anesthesia may contribute to the development of these conditions, but there are little data on the association of age with cognitive recovery from anesthesia in the absence of surgery or underlying medical condition.
We performed a single-center cohort study of healthy adult volunteers 40 to 80 years old (N = 71, mean age 58.5 years, and 44% women) with no underlying cognitive dysfunction. Volunteers underwent cognitive testing before and at multiple time points after 2 hours of general anesthesia consisting of propofol induction and sevoflurane maintenance, akin to a general anesthetic for a surgical procedure, although no procedure was performed. The primary outcome was time to recovery to cognitive baseline on the Postoperative Quality of Recovery Scale (PQRS) within 30 days of anesthesia. Secondary cognitive outcomes were time to recovery on in-depth neuropsychological batteries, including the National Institutes of Health Toolbox and well-validated paper-and-pencil tests. The primary hypothesis is that time to recovery of cognitive function after general anesthesia increases across decades from 40 to 80 years of age. We examined this with discrete-time logit regression (for the primary outcome) and linear mixed models for interactions of age decade with time postanesthesia (for secondary outcomes).
There was no association between age group and recovery to baseline on the PQRS; 36 of 69 (52%) recovered within 60-minute postanesthesia and 63 of 69 (91%) by day 1. Hazard ratios (95% confidence interval) for each decade compared to 40- to 49-year olds were: 50 to 59 years, 1.41 (0.50-4.03); 60 to 69 years, 1.03 (0.35-3.00); and 70 to 80 years, 0.69 (0.25-1.88). There were no significant differences between older decades relative to the 40- to 49-year reference decade in recovery to baseline on secondary cognitive measures.
Recovery of cognitive function to baseline was rapid and did not differ between age decades of participants, although the number in each decade was small. These results suggest that anesthesia alone may not be associated with cognitive recovery in healthy adults of any age decade.
术后谵妄和术后认知功能障碍是老年手术患者最常见的并发症。全身麻醉可能导致这些情况的发生，但在没有手术或潜在疾病的情况下，关于年龄与麻醉后认知恢复的关联的数据很少。
我们对 71 名 40 至 80 岁（平均年龄 58.5 岁，44%为女性）、无潜在认知障碍的健康成年志愿者进行了一项单中心队列研究。志愿者在接受丙泊酚诱导和七氟醚维持的 2 小时全身麻醉前后，以及在全身麻醉后 30 天内，多次接受认知测试，类似于手术过程中的全身麻醉，但不进行任何手术。主要结局是术后恢复质量量表（PQRS）在 30 天内恢复到认知基线的时间。次要认知结局是在深入的神经心理测试中恢复的时间，包括美国国立卫生研究院工具包和经过充分验证的纸笔测试。主要假设是，从 40 岁到 80 岁，全身麻醉后认知功能恢复的时间会随着十年的推移而增加。我们使用离散时间逻辑回归（主要结局）和线性混合模型检验了年龄与麻醉后时间的相互作用（次要结局）。
PQRS 上的年龄组与恢复到基线之间没有关联；69 人中的 36 人（52%）在麻醉后 60 分钟内恢复，69 人中的 63 人（91%）在第 1 天恢复。与 40 至 49 岁年龄组相比，每十年的风险比（95%置信区间）为：50 至 59 岁，1.41（0.50-4.03）；60 至 69 岁，1.03（0.35-3.00）；70 至 80 岁，0.69（0.25-1.88）。在次要认知测量中，与 40 至 49 岁的参考年龄组相比，较年长的年龄组在恢复到基线方面没有显著差异。
认知功能迅速恢复到基线水平，且在参与者的年龄十年之间没有差异，尽管每个年龄组的人数都很少。这些结果表明，在任何年龄阶段的健康成年人中，麻醉本身可能与认知恢复无关。
