Cognitive Failures After General Anesthesia Are Probably Not Related to the Type of Anesthetic Used

Abstract

To the editor: Because of our previous studies on the cognitive function in the elderly patients, we read the study by Chen et al. (1) with great interest. Postoperative cognitive dysfunction is especially hazardous for the patient when discharged after day-case surgery. Tests such as Mini-Mental State may show a decline in memory efficiency, but may not reflect highly practiced everyday memory skills. Using Broadbent Cognitive Failures Questionnaire (CFQ), a standard measure of mistakes that commonly occur in everyday life (2), we previously compared the cognitive failures over 3 days after halothane, isoflurane, sevoflurane or propofol anesthesia for day-case cystoscopic surgery and found that 50% of 115 patients had worse CFQ scores after anesthesia compared with the preoperative scores without any difference between groups (3). Although Chen et al. (1) also hoped that the recently introduced short-acting drugs would further improve cognitive outcome by providing fast exit and early return to normal daily activities, they failed to show any clinically significant effect of the anesthetics used. Cognitive complaints after surgery may reflect both actual changes in cognitive performance and other factors such as anxiety, stress of the surgery, and depression (4). We think various factors such as age, limited education, second operation, and rocky postoperative course (5) rather than the type of the anesthetic may explain the relative success of the patients’ adaptations to surgical stress, perioperative anxiety, and ultimately the cognitive function after surgery, so further studies should evaluate these factors more closely. Elif Basgul, MD Seda B. Akinci, MD