PMID- 31651458
OWN - NLM
STAT- MEDLINE
DCOM- 20200902
LR  - 20221005
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Print)
IS  - 0003-2999 (Linking)
VI  - 131
IP  - 2
DP  - 2020 Aug
TI  - Anesthesia With and Without Nitrous Oxide and Long-term Cognitive Trajectories in 
      Older Adults.
PG  - 594-604
LID - 10.1213/ANE.0000000000004490 [doi]
AB  - BACKGROUND: We evaluated the hypothesis that the rate of postoperative decline in 
      global cognition is greater in older adults exposed to general anesthesia with 
      nitrous oxide (N2O) compared to general anesthesia without N2O. METHODS: 
      Longitudinal measures of cognitive function were analyzed in nondemented adults, 
      70-91 years of age, enrolled in the Mayo Clinic Study of Aging. Linear 
      mixed-effects models with time-varying covariates assessed the relationship 
      between exposure to surgery with general anesthesia (surgery/GA) with or without 
      N2O and the rate of long-term cognitive changes. Global cognition and 
      domain-specific cognitive outcomes were defined using z scores, which measure how 
      far an observation is, in standard deviations, from the unimpaired population 
      mean. RESULTS: The analysis included 1819 participants: 280 exposed to GA without 
      N2O following enrollment and before censoring during follow-up (median 
      [interquartile range IQR] follow-up of 5.4 [3.9-7.9] years); 256 exposed to GA 
      with N2O (follow-up 5.6 [4.0-7.9] years); and 1283 not exposed to surgery/GA 
      (follow-up 4.1 [2.5-6.4] years). The slope of the global cognitive z score was 
      significantly more negative following exposure to surgery/GA after enrollment 
      (change in slope of -0.062 [95% confidence interval CI, -0.085 to -0.039] for 
      GA without N2O, and -0.058 [95% CI, -0.080 to -0.035] for GA with N2O, both P < 
      .001). The change in slope following exposure to surgery/GA did not differ 
      between those exposed to anesthesia without versus with N2O (estimated difference 
      -0.004 [95% CI, -0.035 to 0.026], P = .783). CONCLUSIONS: Exposure to surgery/GA 
      is associated with a small, but statistically significant decline in cognitive z 
      scores. Cognitive decline did not differ between anesthetics with and without 
      N2O. This finding provides evidence that the use of N2O in older adults does not 
      need to be avoided because of concerns related to decline in cognition.
FAU - Sprung, Juraj
AU  - Sprung J
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Abcejo, Arnoley S Arney
AU  - Abcejo ASA
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Knopman, David S
AU  - Knopman DS
AD  - Department of Neurology.
AD  - Division of Epidemiology, Department of Health Sciences Research.
FAU - Petersen, Ronald C
AU  - Petersen RC
AD  - Department of Neurology.
AD  - Division of Epidemiology, Department of Health Sciences Research.
FAU - Mielke, Michelle M
AU  - Mielke MM
AD  - Department of Neurology.
AD  - Division of Epidemiology, Department of Health Sciences Research.
FAU - Hanson, Andrew C
AU  - Hanson AC
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Schroeder, Darrell R
AU  - Schroeder DR
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Schulte, Phillip J
AU  - Schulte PJ
AD  - Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Martin, David P
AU  - Martin DP
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Weingarten, Toby N
AU  - Weingarten TN
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Pasternak, Jeffrey J
AU  - Pasternak JJ
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Warner, David O
AU  - Warner DO
AD  - From the Department of Anesthesiology and Perioperative Medicine.
LA  - eng
GR  - P50 AG016574/AG/NIA NIH HHS/United States
GR  - R01 AG034676/AG/NIA NIH HHS/United States
GR  - U01 AG006786/AG/NIA NIH HHS/United States
GR  - UL1 TR000135/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Anesthetics, Inhalation)
RN  - K50XQU1029 (Nitrous Oxide)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthetics, Inhalation/*administration & dosage/adverse effects
MH  - Cognition/*drug effects/physiology
MH  - Cognitive Dysfunction/*chemically induced/*diagnosis/psychology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Nitrous Oxide/*administration & dosage/adverse effects
PMC - PMC7165021
MID - NIHMS1066097
COIS- Conflicts of Interest: None.
EDAT- 2019/10/28 06:00
MHDA- 2020/09/04 06:00
PMCR- 2021/08/01
CRDT- 2019/10/26 06:00
PHST- 2019/10/28 06:00 [pubmed]
PHST- 2020/09/04 06:00 [medline]
PHST- 2019/10/26 06:00 [entrez]
PHST- 2021/08/01 00:00 [pmc-release]
AID - 00000539-202008000-00038 [pii]
AID - 10.1213/ANE.0000000000004490 [doi]
PST - ppublish
SO  - Anesth Analg. 2020 Aug;131(2):594-604. doi: 10.1213/ANE.0000000000004490.