Impairment of sustained attention after major gynaecological surgery *

Dale, M. T.; Naik, R. Pandu; Williams, John P.; Lloyd, Andrew; Thompson, Jonathan P.

doi:10.1017/s0265021505001420

Cited by 13 publications

(4 citation statements)

References 10 publications

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“…Moreover, considering cognition alone, the extent to which deficits in elements of attention and other cognitive domains, e.g., executive function, occur separately is unknown. The evidence suggests a complex picture [11][12][13][14][15].…”

Section: Cognitive Deficits In Deliriummentioning

confidence: 99%

Defining delirium for the International Classification of Diseases, 11th Revision

Meagher

MacLullich

Laurila

2008

Journal of Psychosomatic Research

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Section: Cognitive Deficits In Deliriummentioning

confidence: 99%

Defining delirium for the International Classification of Diseases, 11th Revision

Meagher

MacLullich

Laurila

2008

Journal of Psychosomatic Research

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“…Research on return to baseline function focuses on psychomotor testing and driving simulation and as one would expect, older studies show prolonged effects after anesthesia [3,5]. It isn't clear which psychomotor tests correlate best with return to preoperative function.…”

Section: Anesthesia Recoverymentioning

confidence: 99%

“…A responsible escort/caregiver has been a mainstay of ambulatory anesthesia practice ever since. That probably made good sense when using last century's anesthetics, with their relatively extended effects on psychomotor recovery [2][3][4][5]. Today's modern short-acting anesthetics, particularly propofol, call into question this long held dogma.…”

Section: Introductionmentioning

confidence: 99%

Discharging select patients without an escort after ambulatory anesthesia: identifying return to baseline function

Walsh

2021

Current Opinion in Anaesthesiology

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Purpose of reviewThe current standard of care requires ambulatory surgical patients to have an escort for discharge. Recent studies have started to challenge this dogma. Modern ultrashort acting anesthetics have minimal psychomotor effects after a couple of hours. Driving simulator performance and psychomotor testing return to baseline as soon as 1 h following propofol sedation. Recent findingsTwo recent reports of actual experience with thousands of patients found no increase in complications in patients who were discharged without escort or drove themselves from a sedation center. These studies suggest discharge without escort may be safe in select patients but a method to identify appropriate patients remains undefined. SummaryA reliable test to document return of function might allow safe discharge without an escort. Currently, there is intense interest in developing reliable, inexpensive, easy to administer psychomotor function testing to improve workplace safety and legally define the effects of drugs on driving impairment. Future studies may be able to adapt this technology and develop a validated test for residual anesthetic impairment.

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“…This has implications following surgery for return to work, school, or even routine activities of daily living which may be dependent on maximal reaction speed and focus such as slicing vegetables or driving a car. 1,2…”

Section: Introductionmentioning

confidence: 99%

Incisional Nociceptive Input Impairs Attention-related Behavior and Is Associated with Reduced Neuronal Activity in the Prefrontal Cortex in Rats

et al. 2018

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Cognitive capacity may be reduced from inflammation, surgery, anesthesia, and pain. In this study, we hypothesized that incision-induced nociceptive input impairs attentional performance and alters neuronal activity in the prefrontal cortex. Methods Attentional performance was measured in rats by using the titration variant of the 5-choice serial reaction time to determine the effect of surgical incision and anesthesia in a visual attention task. Neuronal activity (single spike and local field potentials) was measured in the medial prefrontal cortex in animals during the task. Results Incision significantly impaired attention postoperatively (area under curve of median cue duration-time 97.2 ± 56.8 [n = 9] vs. anesthesia control 25.5 ± 14.5 s-days [n = 9], P = 0.002; effect size, η2 = 0.456). Morphine (1 mg/kg) reduced impairment after incision (area under curve of median cue duration-time 31.6 ± 36.7 [n = 11] vs. saline 110 ± 64.7 s-days [n = 10], P < 0.001; η2 = 0.378). Incision also decreased cell activity (n = 24; 1.48 ± 0.58 vs. control, 2.93 ± 2.02 bursts/min; P = 0.002; η2 = 0.098) and local field potentials (n = 28; η2 = 0.111) in the medial prefrontal cortex. Conclusions These results show that acute postoperative nociceptive input from incision reduces attention-related task performance and decreases neuronal activity in the medial prefrontal cortex. Decreased neuronal activity suggests nociceptive input is more than just a distraction because neuronal activity increases during audiovisual distraction with similar behavioral impairment. This suggests that nociceptive input and the medial prefrontal cortex may contribute to attentional impairment and mild cognitive dysfunction postoperatively. In this regard, pain may affect postoperative recovery and return to normal activities through attentional impairment by contributing to lapses in concentration for routine and complex tasks.

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Impairment of sustained attention after major gynaecological surgery *

Abstract: The results of this study suggest that 72 h following major surgery patients have deficits in sustained attention compared with controls. Control subjects demonstrated a marked learning effect on repeated test performance compared with patients.

Cited by 13 publications

References 10 publications

Defining delirium for the International Classification of Diseases, 11th Revision

Defining delirium for the International Classification of Diseases, 11th Revision

Discharging select patients without an escort after ambulatory anesthesia: identifying return to baseline function

Incisional Nociceptive Input Impairs Attention-related Behavior and Is Associated with Reduced Neuronal Activity in the Prefrontal Cortex in Rats

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