Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T12:06:54.200Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychomotor dysfunction after remifentanil/propofol anaesthesia

Published online by Cambridge University Press:  01 April 2007

I. Dressler ,
T. Fritzsche ,
K. Cortina ,
F. Pragst ,
C. Spies  and
I. Rundshagen
I. Dressler
Affiliation:
University Hospital Charité, Department of Anaesthesiology, Berlin, Germany
T. Fritzsche
Affiliation:
University Hospital Charité, Department of Anaesthesiology, Berlin, Germany
K. Cortina
Affiliation:
University of Michigan, Department of Psychology, Ann Arbor, MI, USA
F. Pragst
Affiliation:
University Hospital Charité, Department of Legal Medicine, Berlin, Germany
C. Spies
Affiliation:
University Hospital Charité, Department of Anaesthesiology, Berlin, Germany
I. Rundshagen
Affiliation:
University Hospital Charité, Department of Anaesthesiology, Berlin, Germany
Get access

Summary

Background and objectives

Early recovery after anaesthesia is gaining importance in fast track management. The aim of this study was to quantify psychomotor recovery within the first 24 h after propofol/remifentanil anaesthesia using the Short Performance Test (Syndrom Kurztest (SKT)), consisting of nine subtests. The hypothesis was that psychomotor performance remains reduced 24 h after anaesthesia.

Methods

Thirty-seven patients scheduled for elective surgery took part in the study. The SKT was performed on the day before general anaesthesia (T0), 10, 30, 90 min and 24 h after extubation (T1). Parallel versions were used to minimize learning effects. Anaesthesia was introduced and maintained with remifentanil/propofol as a target controlled infusion. Propofol plasma concentration was measured 10 and 90 min after extubation. Perioperative pain management included novaminsulfon and piritramide.

Results

Up till 90 min after surgery and anaesthesia, psychomotor performances were significantly reduced as the lower test results in all SKT subtests indicated (P ⩽ 0.007 vs. baseline T0). In the three memory subtests (ST 2, ST 8 and ST 9), psychomotor performance was still reduced on the first postoperative day (P ⩽ 0.005; T1 vs. T0). There was no correlation between propofol plasma concentration and the psychometric test results.

Conclusions

Propofol/remifentanil-based target controlled general anaesthesia for surgery is associated with a reduced psychomotor function up to the first postoperative day. Further studies are needed to confirm the usefulness of the SKT in the perioperative period and to clarify which components in the perioperative period are responsible for a lower performance in the SKT.

Keywords

POSTOPERATIVE PERIODANAESTHESIA RECOVERY PERIOD, cognitive functionPSYCHOMETRICS, short performance testANAESTHESIA GENERALPROPOFOLREMIFENTANIL
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 347 - 354
Copyright
Copyright © European Society of Anaesthesiology 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Biedler, A, Juckenhöfel, S, Feisel, C, Wilhelm, W, Larsen, R. Cognitive impairment in the early postoperative period after remifentanil-propofol and sevoflurane-fentanyl anesthesia. Anaesthesist 2000; 49: 286–290.CrossRefGoogle ScholarPubMed
2.Kubitz, J, Epple, J, Bach, A, Motsch, J, Martin, E, Schmidt, H. Psychomotor recovery in very old patients after total intravenous or balanced anaesthesia for cataract surgery. Br J Anaesth 2001; 86: 203–208.CrossRefGoogle ScholarPubMed
3.Rundshagen, I, Schnabel, K, Schulte am Esch, J. Recovery of memory performance after general anaesthesia: clinical and electrophysiologic findings. Br J Anaesth 2002; 88: 362–368.CrossRefGoogle Scholar
4.Heath, PJ, Ogg, TW, Gilks, WR. Recovery after day-case anaesthesia. A 24-h comparison of recovery after thiopentone or propofol anaesthesia. Anaesthesia 1990; 45: 911–915.CrossRefGoogle ScholarPubMed
5.Tzabar, Y, Asbury, AJ, Millar, K. Cognitive failures after general anaesthesia for day case surgery. Br J Anaesth 1996; 76: 194–197.CrossRefGoogle ScholarPubMed
6.Moller, JT, Cluitmans, P, Rasmussen, LS et al. . Long-term postoperative cognitive dysfunction in the elderly: ISPOCD 1 study. Lancet 1998; 351: 857–861.CrossRefGoogle Scholar
7.Canet, J, Raeder, J, Rasmussen, LS et al. . Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003; 47: 1204–1210.CrossRefGoogle ScholarPubMed
8.Rasmussen, LS, Johnson, T, Kuipers, HM et al. . Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand 2003; 47: 260–266.CrossRefGoogle ScholarPubMed
9.Erzigkeit, H. The SKT: a short cognitive performance test as an instrument for the assessment of clinical efficacy of cognition enhancers. In: Bergner, M, Reisberg, B, eds. Diagnosis and Treatment of Senile Dementia. Berlin: Springer, 1989: 164–174.CrossRefGoogle Scholar
10.Lehfeld, H, Erzigkeit, H. The SKT – a short cognitive performance test for assessing deficits of memory and attention. Int Psychogeriatr 1997; 9 (Suppl 1): 115–121.CrossRefGoogle Scholar
11.Overall, JE, Schaltenbrand, R. The SKT neurophsychological test battery. J Geriatr Psychiatry Neurol 1992; 5: 220–227.CrossRefGoogle Scholar
12.Schlager, A, Morawetz, RF, Huber, C, Furtwaengler, W, Luger, TJ, Schreithofer, D. Residual impairment of cognitive abilities and reaction time caused by midazolam after reversion with flumazenil. Anaesthesist 1991; 40: 33–38.Google Scholar
13.Engelhardt, W, Stahl, K, Marouche, A, Hartung, E. Recovery time after (S)-ketamine or ketamine racemate. Recovery time after short anesthesia in volunteers. Anaesthesist 1998; 47: 184–192.CrossRefGoogle ScholarPubMed
14.Lehfeld, H, Rudinger, G, Rietz, C et al. . Evidence of the cross-cultural stability of the factor structure of the SKT short test for assessing deficits of memory and attention. Int Psychogeriatr 1997; 9 (Suppl 2): 139–153.CrossRefGoogle ScholarPubMed
15.Fornazzari, L, Cumsille, F, Quevedo, F et al. . Spanish validation of the Syndrom Kurztest (SKT). Alzheimer Dis Assoc Disord 2001; 15: 211–215.CrossRefGoogle ScholarPubMed
16.Pragst, F, Herzler, M, Erxleben, BT. Systematic toxicological analysis by high-performance liquid chromatography with diode array detection (HPLC-DAD). Clin Chem Lab Med 2004; 42: 1325–1340.CrossRefGoogle ScholarPubMed
17.Parikh, SS, Chung, F. Postoperative delirium in the elderly. Anesth Analg 1995; 80: 1223–1232.Google ScholarPubMed
18.Erzigkeit, H. SKT Manual. Weinheim, Germany: Beltz Test GmbH, 1989.Google Scholar
19.Kim, YS, Nibbelink, DW, Overall, JE. Factor structure and scoring of the SKT test battery. J Clin Psychol 1993; 49: 61–71.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
20.Ihl, R, Grass-Kapanke, B, Jaenner, M, Weyer, G. Neurospychometric tests in cross sectional and longitudinal studies – a regression analysis of ADAS – Cog, SKT and MMSE. Pharmacopsychiatry 1999; 32: 248–254.CrossRefGoogle ScholarPubMed
21.Bekker, AY, Berklayd, P, Osborn, I, Bloom, M, Yarmush, J, Turndorf, H. The recovery of cognitive function after remifentanil nitrous oxide anesthesia is faster than after an isoflurane nitrous oxide-fentanyl combination in elderly patients. Anesth Analg 2000; 91: 117–122.CrossRefGoogle ScholarPubMed
22.Chen, X, Zhao, M, White, P et al. . The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg 2001; 93: 1489–1494.CrossRefGoogle ScholarPubMed
23.Helkala, EL, Kivipelto, M, Hallikainen, M et al. . Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure – a population-based study. Acta Neurol Scand 2002; 106: 341–346.CrossRefGoogle ScholarPubMed