The Features Of Cognitive Recovery And Correlation With Emergence Agitation After General Anesthesia

Objective To investigate the features of cognitive recovery and correlation withemergence agitation (EA) after general anesthesiaMethods Three hundred and sixty-nine ASA I or II patients aged18~79yr,weight41~99kg undergoing non cardiac or brain surgery were included in thisstudy. Emergence agitation was assessed at15~40min after extubation(T1-2) andthe cognitive functions were assessed at day1before operation(T0) and day1-7(T3-5) postoperatively by using Post-operative Quality Recovery Scale (PQRS).Patients whose score for agitation was1-2were divided into EA group at T1-2andwhose five cognitive texts returned to the baseline were divided into unrecoveredcognitive group. According to the different age stratification patients werecategorized as young(18-44yr), middle-aged (45-59yr), or elderly (60yr or older).Demographic, preoperative complications and types of surgery of patients wererecorded. The factors associated with EA and unrecovered cognitive by singlefactor analysis were included in the logistic regression analysis.Results The incidence of EA was23.04%. Compare with non-emergenceagitation patients, there was a statistically association between EA with age,gender, ASA physical status, preoperative anxiety, duration of anesthesia, types ofsurgery and emergence hyoxemia, state of consciousness, pain (P<0.05); there is asignificant difference in the percentage of unrecovered cognitive between EA andnon-EA subgroup at D1(45.88%vs33.10%， P=0.031), after that there was nodifference in recovery rate at D3or D7. Logistic regression analysis results- indicated that the risk degree associated with EA in a descending order wereconsciousness state(P=0.000， OR=3.995), preoperative anxiety (P=0.001，OR=2.706), male (P=0.015， OR=2.023), hypoxemia(P=0.037， OR=1.818),younger(P=0.006， OR=0.594) and nociceptive pain(P=0.020， OR=1.525).The incidence of unrecovered cognitive was40.92%.Compare with recoveredcognitive patients, there was a statistically significant association betweenunrecovered cognitive with age, ASA physical status, history of hypertension,emergence hyoxemia, duration of anesthesia, emergence agitation and depressionpostoperatively (P<0.05). Logistic regression analysis results indicated that therisk degree associated with unrecovered cognitive in a descending order weredepression at day3postoperatively (P=0.012， OR=2.487), emergenceagitation(P=0.003， OR=2.385), depression at day1postoperatively (P=0.038，OR=2.151), age(P=0.002， OR=1.610) and duration of anesthesia (P=0.011，OR=1.500).Compare with the elderly patients, the incidence of emergence agitation inyoung and middle-aged group were higher(P=0.002,P=0.004); the percentage ofunrecovered cognitive in young and middle-aged group were lower at T3(P=0.021,P=0.048) and the percentage of unrecovered cognitive in young groupwas lower at T4or T5(P=0.039,P=0.028).There is a significant difference in thepercentage of unrecovered cognitive between EA and non-EA patients inmiddle-aged group at T3(48.48%vs26.44%， P=0.021), after that there was nodifference in recovery rate in young or elderly group and at T4or T5.Conclusion1. The risk degree associated with EA in a descending order wereconsciousness state, preoperative anxiety, male, hypoxemia, younger, andnociceptive pain. 2. The risk degree associated with unrecovered cognitive in a descendingorder were depression at day3, emergence agitation, depression at day1, age andduration of anesthesia.3. An emergence agitation may predict an acute cognitive disorder within24h,especially in middle-aged patients, after general anesthesia rather than a long-termdelay of postoperative cognitive prognosis.