| 1. |
If you were to have surgery with general anesthesia, would you feel anxiety about possible postoperative cognitive loss? |
1 |
2 |
3 |
4 |
5 |
| 15 (6.4) |
40 (17.1) |
41 (17.5) |
67 (28.6) |
71 (30.3) |
| 2. |
If you could choose anesthetic regimen prior to surgery, for inguinal hernia, which method would you prefer?
|
Combined anesthesia
20 (8.5) |
GA
29 (12.4) |
LA + sedation
12 (5.1) |
Regional anesthesia
141 (60.3) |
TIVA
32 (13.7) |
| 3. |
At the time of preoperative assessment, which factors do you think should influence the choice of anesthetic? |
1 |
2 |
3 |
4 |
5 |
| Patient wish |
2 (0.9) |
21 (9) |
34 (14.5) |
106 (45.3) |
71 (30.3) |
| Risk of postoperative nausea |
0 (0) |
13 (5.6) |
22 (9.4) |
98 (41.9) |
101 (43.2) |
| Risk of postoperative pain |
1 (0.4) |
4 (1.7) |
6 (2.6) |
64 (27.4) |
159 (67.9) |
| Risk of postoperative neurocognitive effects |
2 (0.9) |
7 (3) |
20 (8.5) |
73 (31.2) |
132 (56.4) |
| Risk of adverse cardiac events |
1 (0.4) |
3 (1.3) |
6 (2.6) |
35 (15) |
189 (80.8) |
| Risk of adverse pulmonary events |
1 (0.4) |
2 (0.9) |
3 (1.3) |
40 (17.1) |
188 (80.3) |
| 4. |
During preoperative assessment which of the following cognitive states do you take into account? |
1 |
2 |
3 |
4 |
5 |
| Postoperative delirium |
2 (0.9) |
11 (4.7) |
33 (14.1) |
106 (45.3) |
82 (35) |
| Postoperative cognitive dysfunction |
2 (0.9) |
6 (2.6) |
30 (12.8) |
90 (38.5) |
106 (45.3) |
| Emergence agitation |
1 (0.4) |
20 (8.5) |
52 (22.2) |
104 (44.4) |
57 (24.4) |
| Awareness |
1 (0.4) |
1 (0.4) |
4 (1.7) |
59 (25.2) |
169 (72.2) |
| 5. |
How important do you consider for the following risk factors in the occurrence for postoperative cognitive disorders?
|
1 |
2 |
3 |
4 |
5 |
| Age >70 years old |
0 (0) |
3 (1.3) |
2 (0.9) |
44 (18.8) |
185 (79.1) |
| Male gender |
19 (8.1) |
28 (12) |
109 (46.6) |
56 (23.9) |
22 (9.4) |
| Lower education
|
10 (4.3) |
28 (12) |
89 (38) |
72 (30.8) |
35 (15) |
| Extensive surgery |
1 (0.4) |
3 (1.3) |
8 (3.4) |
79 (33.8) |
143 (61.1) |
| Previous myocardial infarction |
11 (4.7) |
19 (8.1) |
60 (25.6) |
78 (33.3) |
66 (28.2) |
| Previous stroke |
1 (0.4) |
5 (2.1) |
21 (9) |
82 (35) |
125 (53.4) |
| Diabetes |
5 (2.1) |
16 (6.8) |
50 (21.4) |
117 (50) |
46 (19.7) |
| Hypertension
|
5 (2.1) |
22 (9.4) |
71 (30.3) |
98 (41.9) |
38 (16.2) |
| Alcohol abuse
|
0 (0) |
4 (1.7) |
10 (4.3) |
83 (35.5) |
137 (58.5) |
| Severity scoring in critical ill
|
0 (0) |
7 (3) |
27 (11.5) |
74 (31.6) |
126 (53.8) |
| ASA physical score
|
3 (1.3) |
13 (5.6) |
34 (14.5) |
110 (47) |
74 (31.6) |
6.
i) |
Are anesthesia depth monitors available at your hospital?
|
Yes - 226 (96.6) |
No - 8 (3.4) |
|
|
|
| ii) |
If yes, when do you use them? |
Always / almost always
126 (55.8) |
When it is available
45 (19.9) |
Only in high risk patients
43(19) |
Only during GA with muscle relaxation
10 (4.5) |
Rarely
2 (0.9) |
7.
a) |
If you undergo surgery yourself, would you like an anesthesia depth monitor to be used?
|
1 |
2 |
3 |
4 |
5 |
| 2 (0.9) |
3 (1.3) |
9 (3.8) |
42 (17.9) |
178 (76.1) |
| b) |
Would you use an anesthesia depth monitor to reduce the risk of awareness? |
1 (0.4) |
3 (1.3) |
10 (4.3) |
51 (21.8) |
169 (72.2) |
| c) |
Do you think that an EEG based monitor is a reliable method for controlling the anesthesia depth?
|
0 (0) |
7 (3) |
24 (10.3) |
127 (54.3) |
76 (32.5) |
| d) |
Do you think they are too expensive to be used? |
134 (57.3) |
60 (25.6) |
22 (9.4) |
11 (4.7) |
7 (3) |
8.
i) |
In the U.S., anesthetic depth measurement is very common with general anesthesia. In UK, The National institute for Clinical Excellence guidance (NICE) (Nov 2012) recommended anesthetic depth measurement as a possible choice for general anesthesia in patients at risk (for adverse outcomes) and with TIVA. Do you think that anesthesia depth monitors should be used in high risk patients or TIVA?
|
1 |
2 |
3 |
4 |
5 |
| 8 (3.4) |
22 (9.4) |
18 (7.7) |
41 (17.5) |
145 (62) |
| ii) |
Or for all patients?
|
5 (2.3) |
24 (11.1) |
26 (12) |
71 (32.9) |
90 (41.7) |
| 9. |
Today, we routinely assess patients regarding for example clinical status. Do you think it would be useful to assess neurocognitive function preoperatively (MMSE or other) to detect patients at risk to develop postoperative delirium or postoperative cognitive dysfunction? |
1 |
2 |
3 |
4 |
5 |
| 1 (0.4) |
11 (4.7) |
38 (16.2) |
96 (41) |
88 (37.6) |
| Case study 1: Postoperative delirium. Female patient, 75 years old, no chronic medication; is admitted for urgent femur fracture surgical repair. Pain is relieved with opioids. Oxygen saturation is 88%, blood pressure 160/110 mmHg, heart rate 110 bpm. She has fever, is agitated and confused, has trouble in giving adequate answers. |
10.
a) |
Do you have a written protocol regarding preoperative anxiolytics agents for patients at high risk for postoperative delirium? |
Yes - 14 (6) |
No - 196 (83.8) |
Don't know - 24 (10.3) |
|
|
| b) |
If yes, is this protocol followed? |
Yes - 9 (3.8) |
No - 1 (7.1) |
Don't know - 4 (28.6) |
|
|
11.
a) |
Do you have a written protocol regarding preoperative analgesic agents for patients at high risk for postoperative delirium? |
Yes - 9 (3.8) |
No - 203 (86.8) |
Don't know - 22 (9.4) |
|
|
| b) |
If yes, is this protocol followed? |
Yes - 8 (88.9) |
No - 1 (11.1) |
|
|
|
| 12. |
What anesthetic method would you choose for the above described patient?
|
Spinal blockade 108 (46.2) |
Sequential blockade 33 (14.1) |
Combined (GA + PNB) 45 (19.2) |
Combined (GA + NB) 7 (3) |
GA 27 (11.5) |
| 13. |
In case of a general anesthesia, would you use an anesthesia depth monitor?
|
Yes - 217 (92.7) |
No - 17 (7.3) |
|
|
|
| 14. |
If yes, which? |
BIS - 198 (93) |
Entropy - 5 (2.3) |
Sedline - 4 (1.9) |
CSI - 3 (1.4) |
Others - 3 (1.4) |
| 15. |
In the PACU the patient state worsens, she becomes agitated and tries to pull off the iv access and monitoring. It is not clear if the patient is in pain. What is you first action?
|
Administer analgesic
146 (62.4) |
Administer anxiolytic
26 (11.1) |
Administer analgesic and anxiolytic
59 (25.2) |
Physical containment
3 (1.3) |
|
| 16. |
If you decide to administer an anxiolytic, which class of drug would you choose?
|
Benzodiazepine, such as Midazolam
85 (36.5) |
alfa-2 agonist, such as clonidine/dexmedetomidine
37 (15.9) |
Neuroleptic, such as haloperidol
79 (33.9) |
Hypnotic, such as propofol
32 (13.7) |
|
| 17. |
Is there in your hospital protocols to monitor patients that develop POD |
|
|
|
|
|
| a) |
In the PACU |
Yes - 68 (29.1) |
No - 129 (55.1) |
Don't know - 37 (15.8) |
|
|
| b) |
In the surgical ward |
Yes - 29 (12.4) |
No - 138 (59) |
Don't know - 67 (28.6) |
|
|
| c) |
In Intensive Care Units
|
Yes - 89 (38) |
No - 57 (24.4) |
Don't know - 88 (37.6) |
|
|
| 18. |
Is CAM, CAM-ICU, NuDesc or ICDSC used to screen for POD in the PACU in your hospital?
|
Yes - 35 (15.2) |
No - 143 (62.2) |
Don't know - 52 (22.6) |
|
|
19.
i) |
Do you recall any episode of postoperative delirium in your practice during the last year?
|
Yes - 140 (59.8) |
No - 94 (40.2) |
|
|
|
| ii) |
If yes, how many? |
1 to 5 - 111 (79.3) |
5 to 10 - 20 (14.3) |
More than 10 - 9 (6.4) |
|
|
| Case study 2: Postoperative cognitive dysfunction. 55 years old male patient, farmer, with moderate alcohol consumption and previous coronary bypass. The patient also had a minor stroke but with no functional impact. Recently he had been submitted to gastric resection due to a gastric tumor and in now returning 4 weeks later. The patient is upset, angry, sad and frustrated because he can't plan the day as he previously used to. Says memory is short, it fails, and it that it takes time to figure out what he planned to do. Requires adequate treatment of neurocognitive symptoms. How would a similar patient be handled at your hospital? |
20.
a) |
Is there a written protocol? |
Yes - 4 (1.7) |
No - 185 (79.1) |
Don't know - 45 (19.2) |
|
|
| b) |
Would the patient be submitted to a neurocognitive evaluation? |
Yes - 87 (37.2) |
No - 67 (28.6) |
Don't know - 80 (34.2) |
|
|
| c) |
Would the patient be referred to a neurologist/ neuropsychologist? |
Yes - 103 (44) |
No - 41 (17.5) |
Don't know - 90 (38.5) |
|
|
| d) |
Are you aware of any cases of persisting cognitive impairment in your daily practice? |
Yes - 87 (37.2) |
No - 147 (62.8) |
|
|
|
21.
a) |
Do you believe that postoperative delirium is a neglect area within the field of anesthesia?
|
Yes - 229 (97.9) |
No - 5 (2.1) |
|
|
|
| b) |
Do you believe that postoperative cognitive dysfunction is a neglect area within the field of anesthesia? |
Yes - 227 (97) |
No - 7 (3) |
|
|
|
| c) |
Do you believe that awareness is a neglect area within the field of anesthesia?
|
Yes - 124 (53) |
No - 110 (47) |
|
|
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