Recovery of neurocognitive function after general anesthesia in normal patients and patients with a history of significant alcohol use.

摘要

Postoperative cognitive dysfunction (POCD) affects a significant number of patients and, when prolonged, may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after non-cardiac surgery in elderly patients is also significant (25% at 1 week, 10% at 3 months after surgery). The risk factors, causes and consequences of long term POCD after non-cardiac surgery are not well established; however, advanced age and preexisting cognitive impairment are likely. Self-reported alcohol abuse---an identified risk factor for postoperative delirium, has not been investigated as a risk factor for POCD. The goal of this study was to determine if neurocognitive function is impaired after non-cardiac surgery under general anesthesia in elderly patients with a history of significant alcohol use.; Patients with self-reported alcohol abuse (n=28) and age, gender, education-matched nonalcoholic controls (n=28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n=28) or a corresponding time interval without surgery (n=28). Verbal memory, visuospatial memory and executive functions were assessed. Surgical patients received midazolam (1-2 mg), fentanyl (1-2 ug/kg) and thiopental for induction and sevoflurane for maintenance of anesthesia with an average duration of 3 hours. A neurological examination was performed to exclude patients with potential cerebrovascular damage.; A significant main effect of alcohol use (ANOVA) showed that alcoholic patients in general performed worse with respect to story immediate memory, story delayed memory, and digit span memory. A significant main effect of surgery indicated that surgical patients performed worse than non-surgical patients on the Visual Learning and Retention Test. A significant three-way interaction for five neurocognitive tests: brief visual immediate memory, brief visual delayed memory, semantic fluency, phonemic fluency, and the Stroop test, implied that cognitive performance in the surgical alcoholic group decreased after surgery more than it did in the other three groups.; The results suggest that a history of significant alcohol use in elderly patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities, recent memory and executive functions, which may have important implications for health risks and quality of life.