A nationwide survey of Swedish anesthesiologists and nurse anesthetists has revealed a low awareness of the cognitive side effects that patients are at risk from following surgery.
Surgery and anesthesia are more safe and effective now than ever before. Despite this, minor side effects from anesthesia are common, such as pain, postoperative nausea and residual “hang over.”
Although physicians are focused on minimizing these side effects in order to improve the patient experience, less attention has been paid to the cognitive side effects associated with anesthesia, such as agitation, postoperative delirium and postoperative cognitive dysfunction.
These cognitive side effects can have major implications on level of care, length of hospital stay and on the patient’s perceived quality of care. Children, the elderly and cognitively fragile patients are reported as being the groups most at risk.
However, previous studies have shown that fine-tuning and tailoring the delivery of anesthetic through electroencephalogram (EEG)-based depth-of-anesthesia (DOA) monitoring can reduce patients’ risk for postoperative cognitive side effects.
The researchers behind the new survey – from the Karolinska Institute in Stockholm, Sweden – wanted to investigate what routines are in place for risk assessment and diagnosis of cognitive side effects from anesthesia, and the extent to which DOA monitoring is used by anesthesia personnel in Sweden. They publish their findings in the Annals of Medicine and Surgery.
The survey revealed that, although DOA monitors are present in half of the hospitals where the respondents worked, the monitors are used in only around 20% of at-risk cases.
The researchers also found that the neurocognitive side effect physicians are concerned about is recall of pain during surgery. More than 80% of anesthesiologists reported that recall was the neurocognitive side effect they were most worried about, while less than 40% rated postoperative cognitive dysfunction as the adverse effect they were most concerned about.
“We found that Swedish anesthesia personnel viewed risk assessment, prevention, and handling of postoperative delirium and postoperative cognitive dysfunction of rather low importance. Protocol and/or standardized routines were only rarely implemented,” says senior investigator Prof. Jan G. Jakobsson of the Karolinska Institute’s Department of Anesthesia & Intensive Care.
“Respondents were overall quite skeptical about the value of EEG-based DOA monitors, however their use in patients at risk for awareness was more positive among the nurse anesthetists than the anesthesiologists. This attitude to DOA monitoring may be due to the rather negative stance of the Swedish Council on Health Technology Assessment regarding these devices. This is in contrast to the national guidelines in the UK, which support the use of DOA monitoring in at-risk patients.
The results show there is a need to improve the knowledge of anesthesia personnel about risk factors, prevention and management of postoperative cognitive side effects.”
In their conclusion, Prof. Jackobsson and colleagues debate whether the findings “are surprising or merely to be expected.”
They suggest that anesthesia personnel may be more cautious about the risk of the patient recalling pain or paralysis during surgery, because of the negative publicity that may be associated with these side effects, whereas postoperative agitation and confusion cause less publicity and so may be considered less of a priority.
The researchers admit, however, that “it is not possible to state whether or not the results fully represent the views of the anesthesia community practice in Sweden,” particularly as the survey’s response rate among anesthesiologists was low. Also, the survey did not record whether the respondents were currently taking part in clinical practice.
“Still,” they write in the study, “more than 1,000 responses were compiled and analyzed and thus the profile should provide a reasonable profile of current practice.”
Earlier this year, Medical News Today reported on new research published in the Proceedings of the National Academy of Sciences that examined what happens to the brain when it recovers from the effects of anesthetic.