Banerji Antara, Sleigh Jamie W, Voss Logan J, Garcia Paul S, Gaskell Amy L
Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand.
Department of Anaesthesia and Pain Medicine, Waikato District Health Board, Hamilton, New Zealand.
Front Aging Neurosci. 2022 Oct 4;14:930434. doi: 10.3389/fnagi.2022.930434. eCollection 2022.
The course of neuro-cognitive recovery following anaesthesia and surgery is distinctive and poorly understood. Our objective was to identify patterns of neuro-cognitive recovery of the domains routinely assessed for delirium diagnosis in the post anaesthesia care unit (PACU) and to compare them to the cognitive recovery patterns observed in other studies; thereby aiding in the identification of pathological (high risk) patterns of recovery in the PACU. We also compared which of the currently available tests (3D-CAM, CAM-ICU, and NuDESC) is the best to use in PACU. This was a secondary analysis of data from the Alpha Max study which involved 200 patients aged over 60 years, scheduled for elective surgery under general anaesthesia lasting more than 2 h. These patients were assessed for delirium at 30 min following arrival in the PACU, if they were adequately arousable (Richmond Agitation Sedation Score ≥ -2). All tests for delirium diagnosis (3D-CAM, CAM-ICU, and NuDESC) and the sub-domains assessed were compared to understand temporal recovery of neurocognitive domains. These data were also analysed to determine the best predictor of PACU delirium. We found the incidence of PACU delirium was 35% (3D-CAM). Individual cognitive domains were affected differently. Few individuals had vigilance deficits (6.5%, = 10 CAM-ICU) or disorganized thinking (19% CAM-ICU, 27.5% 3D-CAM), in contrast attention deficits were common (72%, = 144) and most of these patients (89.5%, = 129) were not sedated (RASS ≥ -2). CAM-ICU (27%) and NuDESC (52.8%) detected fewer cases of PACU delirium compared to 3D-CAM. In conclusion, return of neurocognitive function is a stepwise process; Vigilance and Disorganized Thinking are the earliest cognitive functions to return to baseline and lingering deficits in these domains could indicate an abnormal cognitive recovery. Attention deficits are relatively common at 30 min in the PACU even in individuals who appear to be awake. The 3D CAM is a robust test to check for delirium in the PACU.
麻醉和手术后神经认知功能恢复的过程具有独特性，且目前了解甚少。我们的目标是确定在麻醉后护理单元（PACU）中常用于谵妄诊断的常规评估领域的神经认知恢复模式，并将其与其他研究中观察到的认知恢复模式进行比较；从而有助于识别PACU中病理性（高风险）的恢复模式。我们还比较了目前可用的测试（3D - CAM、CAM - ICU和NuDESC）中哪一种最适用于PACU。这是对Alpha Max研究数据的二次分析，该研究纳入了200例60岁以上计划接受持续时间超过2小时全身麻醉的择期手术患者。这些患者在进入PACU 30分钟后，若能充分唤醒（里士满躁动镇静评分≥ -2），则评估其是否发生谵妄。对所有谵妄诊断测试（3D - CAM、CAM - ICU和NuDESC）以及所评估的子领域进行比较，以了解神经认知领域的时间恢复情况。对这些数据进行分析，以确定PACU谵妄的最佳预测指标。我们发现PACU谵妄的发生率为35%（3D - CAM）。各个认知领域受影响的方式不同。很少有人存在警觉性缺陷（6.5%，CAM - ICU中n = 10）或思维紊乱（CAM - ICU中19%，3D - CAM中27.5%），相比之下，注意力缺陷很常见（72%，n = 144），并且这些患者中的大多数（89.5%，n = 129）未处于镇静状态（RASS≥ -2）。与3D - CAM相比，CAM - ICU（27%）和NuDESC（52.8%）检测到的PACU谵妄病例较少。总之，神经认知功能的恢复是一个逐步的过程；警觉性和思维紊乱是最早恢复到基线的认知功能，这些领域中持续存在的缺陷可能表明认知恢复异常。即使在看似清醒的个体中，PACU 30分钟时注意力缺陷也相对常见。3D CAM是检查PACU中谵妄的可靠测试。
