24 h 9 -A NCT-A DST EGD. 30 min 200 P =

Transcription

1 544 * # h 9 EGD EGD -A NCT-A DST 30 min EGD P = P = NCT-A P = EGD 3 Early Postoperative Cognitive Dysfunction after Sedation for Esophagogastroduodenoscopy WU Rui GE Zhizheng DAI Jun XUE Hanbing LI Xiaobo ZHAO Yunjia. Division of Gastroenterology and Hepatology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai Institute of Digestive Disease Shanghai Correspondence to GE Zhizheng zhizhengge@ aliyun. com Background It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy however this recommendation has been queried recently. Aims To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods One hundred adult patients undergoing sedative esophagogastroduodenoscopy EGD were randomly recruited and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-a NCT-A number cancellation test and digit symbol test DST before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results All patients completed the first and second assessment and 124 patients had taken the third assessment. When the discharge criteria were met result of number cancellation test was inferior to that before EGD in sedation group P = Furthermore the results were analyzed by grouping with age number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD respectively P = and P = In control group none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied. Key words Esophagogastroduodenoscopy Deep Sedation Cognition Disorders Patient Discharge Automobile Driving DOI /j. issn * wuyidaoruirui@ 163. com # zhizhengge@ aliyun. com

2 h 0. 9% NaCl ECG BP HR SpO 2 post- 30 s 1 ~ 2 mg /kg operative cognitive dysfunction 3 ~ 10 min 4 L /min HR 1 < 50 /min SpO 2 < 90% esophagogastroduodenoscopy EGD A 1 25 Aldrete % ~ 70% s 86. 5% 24 h 3 DST ~ 9 EGD 90 s NCT-A DST EGD EGD EGD EGD EGD ~ ± EGD ~ ± A NCT min SPSS χ 2 x 珋 ± s MMSE > 26 t 2ASA Ⅰ Ⅱ t P < ASA Ⅲ Ⅳ Ⅴ EGD EGD

3 546 3 DST P > ± min min % EGD ± mg ± mg 5. 6 ± 1. 7 min ± 7. 0 min ± 7. 1 min EGD EGD EGD 62. 0% NCT-A DST P > EGD 30 min DST NCT-A EGD NCT-A 1 20 ~ Aldrete ~ ~ 64 PARS 6 EGD 3 NCT-A P < Korttila P > 0. EGD 3 NCT-A Willey 1 EGD NCT-A Aldrete 10 NCT-A 60% ~ 70% 1 x 珋 ± s EGD n = 100 EGD n = ± ± ± ± ± ± ± ± ± ± ± ± P EGD x 珋 ± s 20 ~ 39 n = ~ 54 n = ~ 64 n = ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± 8. 5 P

4 % NCT-A Padmanabhan DST 18. 5% NCT-A 0. 05% EGD NCT-A 2 mg EGD NCT-A EGD EGD EGD EGD 24 h 30 min 3 NCT-A Riphaus / 1 h 2 h NCT 2 h 1 13 / 2 h Monk 14 Horiuchi 17 1 h NCT NCT < 40 s EGD 1 h

5 548 directed administration of propofol a worldwide safety experience J. Gastroenterology quiz Sipe BW Rex DK Latinovich D et al. Propofol versus midazolam /meperidine for outpatient colonoscopy administration by nurses supervised by endoscopists J. Gastrointest Endosc Padmanabhan U Leslie K Eer AS et al. Early cognitive impairment after sedation for colonoscopy the effect of adding midazolam and /or fentanyl to propofol J. Anesth 1 Willey J Vargo JJ Connor JT et al. Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD J. Gastrointest Endosc Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery J. J Perianesth Nurs Awad IT Chung F. Factors affecting recovery and discharge following ambulatory surgery J. Can J Anaesth Korttila K. Recovery from outpatient anaesthesia. Factors affecting outcome J. Anaesthesia Suppl Dumonceau JM Riphaus A Aparicio JR et al NAAP Task Force Members. European Society of Gastrointestinal Endoscopy European Society of Gastroenterology and Endoscopy Nurses and Associates and the European Society of Anaesthesiology Guideline Non-anesthesiologist administration of propofol for GI endoscopy J. Endoscopy Kankaria A Lewis JH Ginsberg G et al. Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy J. Gastrointest Endosc Korttila K. Recovery after intravenous sedation. A comparison of clinical and paper and pencil tests used in assessing late effects of diazepam J. Anaesthesia Rex DK Deenadayalu VP Eid E et al. Endoscopist- Analg Schwender D Müller A Madler M et al. Recovery of psychomotor and cognitive functions following anesthesia. Propofol / alfentanil and thiopental / isoflurane / alfentanil Article in German J. Anaesthesist Vasudevan AE Goh KL Bulgiba AM. Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy J. Am J Gastroenterol Maslekar S Gardiner A Hughes M et al. Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy J. Br J Surg Monk TG Weldon BC Garvan CW et al. Predictors of cognitive dysfunction after major noncardiac surgery J. Anesthesiology Moerman AT Foubert LA Herregods LL et al. Propofol versus remifentanil for monitored anaesthesia care during colonoscopy J. Eur J Anaesthesiol Riphaus A Gstettenbauer T Frenz MB et al. Quality of psychomotor recovery after propofol sedation for routine endoscopy a randomized and controlled study J. Endoscopy Horiuchi A Nakayama Y Fujii H et al. Psychomotor recovery and blood propofol level in colonoscopy when using propofol sedation J. Gastrointest Endosc