Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery.
Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery.
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DOI：
10.1213/ane.0000000000005824
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发表时间：
2022-02-01
影响因子：
5.7
通讯作者：
Deiner SG
中科院分区：
文献类型：
--
作者：
Baxter MG;Mincer JS;Brallier JW;Schwartz A;Ahn H;Nir T;McCormick PJ;Ismail M;Sewell M;Allore HG;Ramsey CM;Sano M;Deiner SG
术后谵妄和术后认知功能障碍是老年外科患者最常见的并发症。全身麻醉可能促进这些疾病的发展，但在没有手术或基础医疗条件的情况下，关于年龄与麻醉后认知恢复的关系的数据很少。我们对40-80岁健康成人志愿者（N = 71，平均年龄58.5岁，44%为女性）进行了一项单中心队列研究，无潜在认知功能障碍。志愿者在由异丙酚诱导和七氟醚维持组成的全身麻醉2小时之前和之后的多个时间点进行了认知测试，类似于外科手术的全身麻醉，尽管没有进行任何手术。主要观察指标为麻醉后30天内根据术后恢复质量评分（PQRS）恢复到认知基线的时间。次要认知结果是深度神经心理学测试的恢复时间，包括美国国立卫生研究院工具箱和经过验证的纸笔测试。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随着年龄的增长而增加。我们用离散时间logit回归（主要结果）和年龄与麻醉后时间相互作用的线性混合模型（次要结果）来检验这一点。在PQRS上，年龄和恢复到基线之间没有关联；36/69（52%）在麻醉后60分钟内恢复，63/69（91%）在第1天恢复。与40-49岁人群相比，每十年的风险比[95%可信区间]为：50-59岁，1.41 [0.50,4.03]；60 ~ 69岁，1.03 [0.35,3.00]；70-80年，0.69[0.25,1.88]。相对于40-49岁的参考十年，老年十年在次要认知测量中恢复到基线方面没有显著差异。认知功能恢复到基线水平的速度很快，并且在不同年龄的参与者之间没有差异，尽管每个年龄的参与者数量很少。这些结果表明，单独麻醉可能与任何年龄的健康成年人的认知恢复无关。
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 aged 40–80 years old (N = 71, mean age 58.5 years, 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 age decades from 40 to 80 years old. We examined this with discrete-time logit regression (for the primary outcome) and linear mixed models for interactions of age decade with time post-anesthesia (for secondary outcomes). There was no association between age group and recovery to baseline on the PQRS; 36/69 (52%) recovered within 60 minutes post-anesthesia and 63/69 (91%) by day 1. Hazard ratios [95% confidence interval]) for each decade compared to 40–49 year olds were: 50–59 years, 1.41 [0.50, 4.03]; 60–69 years, 1.03 [0.35, 3.00]; 70–80 years, 0.69 [0.25, 1.88]. There were no significant differences between older decades relative to the 40–49 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 number in each decade were small. These results suggest that anesthesia alone may not be associated with cognitive recovery in healthy adults of any age decade.
阿尔茨海默氏症转基因小鼠模型中的麻醉作用。
DOI：
10.1016/j.pnpbp.2012.06.007
发表时间：
2013-12-02
影响因子：
5.6
作者：
Tang, Junxia X.;Eckenhoff, Maryellen F.
通讯作者：
Eckenhoff, Maryellen F.