Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis

Sean Cuninghame; Angela Jerath; Kevin Gorsky; Asaanth Sivajohan; Conall Francoeur; Davinia Withington; Lisa Burry; Brian H Cuthbertson; Beverley A Orser; Claudio Martin; Adrian M Owen; Marat Slessarev; Sedating with Volatile Anesthetics Critically Ill COVID-19 Patients in ICU: Effects on Ventilatory Parameters and Survival study investigators

doi:10.1016/j.bja.2023.05.004

Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis

Br J Anaesth. 2023 Aug;131(2):314-327. doi: 10.1016/j.bja.2023.05.004. Epub 2023 Jun 19.

Authors

Collaborators

Sedating with Volatile Anesthetics Critically Ill COVID-19 Patients in ICU: Effects on Ventilatory Parameters and Survival study investigators:
Martin Chapman, Damon Scales, Julie Nardi, Beth Linseman, Phil Lau, Boris Yakubov, François M Carrier, Emmanuel Charbonney, Michaël Chassé, Martin Girard, Antoine Halwagi, Guillaume Plourde, Han T Wang, Dominique Lafrance, Danielle Corsilli, Catalina Sokoloff, Frédérick D'Aragon, Maxime Tissot-Therrien, François Lamontagne, Dominique Bérard, Yiorgos A Cavayas, Martin Albert, Francis Bernard, Karim Serri, David Williamson, Virginie Williams, Patricia M Barrios, Sabrina A De Franca, Etienne J Couture, Adreanne Côté, Mathieu Simon, Pierre-Alexis Lépine, Dave Gleeton, John Basmaji, Marat Slessarev, Ahmed Hegazy, Tracey Bentall, Eileen Campbell, Michelle Stephens, Tim Winterburn, Roupen Hatzakorzian, Kosar Khwaja, Peter Goldberg, Jason Shahin, Jeremy R Grushka, Jonathan Hooper, Sherissa Microys, Hilary Meggison, David Leilipovitz, Jessica Haines, Irene Watpool, Rebecca Porteous, Stephanie Dunster, Sylvie Bourbonnais, Ewan Goligher, Lorenzo Del Sorbo, Niall Ferguson, Philip Graham, Michael Long, Tina Yan, Denise Morris, Maria Kobylecky, Hesham Abdelhady, Tina Romagnuolo, Ian Randall, Elizabeth Wilcox, Michael Jacka, Oleksa Rewa, Vincent Lau, Sean Bagshaw, Nadia Baig

Affiliations

¹ Department of Medicine, Western University, London, ON, Canada.
² Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Schulich Heart Program, Sunnybrook Research Institute, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
³ Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁵ Centre de Recherche CHU de Québec-Université Laval, Quebec City, QC, Canada.
⁶ Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada.
⁷ Departments of Pharmacy and Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
⁸ Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
⁹ Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁰ Western Institute for Neuroscience, Western University, London, ON, Canada; Department of Psychology and Department of Physiology and Pharmacology, Western University, London, Canada.
¹¹ Department of Medicine, Western University, London, ON, Canada; Western Institute for Neuroscience, Western University, London, ON, Canada. Electronic address: marat.slessarev@lhsc.on.ca.

PMID: 37344338
DOI: 10.1016/j.bja.2023.05.004

Abstract

Background: Sedation of critically ill patients with inhaled anaesthetics may reduce lung inflammation, time to extubation, and ICU length of stay compared with intravenous (i.v.) sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes in this population is unclear. In this systematic review, we aimed to summarise the effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults.

Methods: We searched MEDLINE, EMBASE, and PsycINFO for case series, retrospective, and prospective studies in critically ill adults sedated with inhaled anaesthetics. Outcomes included delirium, psychomotor and neurological recovery, long-term cognitive dysfunction, ICU memories, anxiety, depression, post-traumatic stress disorder (PTSD), and instruments used for assessment.

Results: Thirteen studies were included in distinct populations of post-cardiac arrest survivors (n=4), postoperative noncardiac patients (n=3), postoperative cardiac patients (n=2), and mixed medical-surgical patients (n=4). Eight studies reported delirium incidence, two neurological recovery, and two ICU memories. One study reported on psychomotor recovery, long-term cognitive dysfunction, anxiety, depression, and PTSD. A meta-analysis of five trials found no difference in delirium incidence between inhaled and i.v. sedatives (relative risk 0.95 [95% confidence interval: 0.59-1.54]). Compared with i.v. sedatives, inhaled anaesthetics were associated with fewer hallucinations and faster psychomotor recovery but no differences in other outcomes. There was heterogeneity in the instruments used and timing of these assessments.

Conclusions: Based on the limited evidence available, there is no difference in cognitive and psychiatric outcomes between adults exposed to volatile sedation or intravenous sedation in the ICU. Future studies should incorporate outcome assessment with validated tools during and after hospital stay.

Systematic review protocol: PROSPERO CRD42021236455.

Keywords: cognition; critical care medicine; delirium; post-ICU syndrome; psychiatric; sedation.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Anesthetics*
Cognition
Critical Illness
Delirium*
Humans
Hypnotics and Sedatives
Intensive Care Units
Prospective Studies
Retrospective Studies

Substances

Hypnotics and Sedatives
Anesthetics