Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery – 2018
Reference: The Nomenclature Consensus Working Group. Br J Anaesth. 2018;121(5):1005-1012
Take home message: Postoperative cognitive dysfunction (POCD) has long been recognized, however understanding of POCD has been complicated by significant heterogeneity in the type of tests administered, the definition for POCD, and the timing of administration of the tests. This review provided recommendations of nomenclature for POCD to align with the terminology used in the wider clinical community when assessing cognitive impairment. The recommendations would form a framework to further understand perioperative cognitive impairment, to enhance cross-specialty communication and clinical management of patients. ‘Perioperative neurocognitive disorders' should be used as an overarching term for cognitive impairment identified in the perioperative period, which is further categorised as:
• ‘neurocognitive disorder’ = cognitive decline diagnosed before operation
• ‘postoperative delirium’ = any form of acute event
• ‘delayed neurocognitive recovery’ = cognitive decline diagnosed up to 30 days after the procedure
• ‘postoperative neurocognitive disorder’ = cognitive decline diagnosed up to 12 months after the procedure
Implication of major adverse postoperative events and myocardial injury on disability and survival: a planned subanalysis of the ENIGMA-II Trial
Reference: The ENIGMA-II Investigators. Anesth Analg. 2018;127(5):1118-1126
Take home message: The Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial is an international randomized trial of 6992 noncardiac surgical patients. Using the study cohort from the ENIGMA-II trial, this subanalysis studied the impact of both cardiac and non-cardiac adverse events on 1-year disability-free survival after noncardiac surgery. Four separate types of postoperative adverse events and their survival outcomes were:
• Major adverse cardiac events (MACEs), n=469; aHR=3.36 (95% CI, 2.55-4.46)
• Isolated troponin elevation, n=754; aHR= 1.87 (95% CI, 1.40–2.52)
• Major adverse postoperative events (MAPEs) without troponin elevation, n=501; aHR=2.98 (95% CI, 2.26-3.92)
• MAPEs with isolated troponin elevation, n=116; aHR=4.29 (95% CI, 2.89-6.36)
MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. Isolated troponin elevation, which occurred both with and without MAPEs, decreased survival to a varied extent.
Association between perioperative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study
Reference: STARSurg Collaborative. Anaesthesia. 2018;73(10):1214-1222
Take home message: In this study, 60.4% of the study cohort had their angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-2 receptor blockers (ARBs) withheld during the perioperative period. There was no difference in the incidence of acute kidney injury between patients who had their ACEis or ARBs continued or withheld (18.7% vs 18.1%, respectively; p = 0.914).