Compiled by Deborah J. Culley, M.D.
Brigham and Women’s Hospital, Boston, Massachusetts

CNS Dysfunction, "Normal" Recovery

1. Apfelbaum JL, Lichtor JL, Lane BS, Coalson DW, Korttila KT: Awakening, clinical recovery, and psychomotor effects after desflurane and propofol anesthesia. Anesth Analg 83:721-725, 1996.

+2. Bruce DL, Bach MJ, Arbit J: Trace anesthetic effects on perceptual, cognitive, and motor skills. Anesthesiology 40:453-458, 1974.

3. Cheam EW, Dob DP, Skelly AM, Lockwood GG: The effect of nitrous oxide on the performance of psychomotor tests. A dose-response study. Anaesthesia 50:764-768, 1995.

4. Chung F, Seyone C, Dyck B, Chung A, Ong D, Taylor A, Stone R: Age-related cognitive recovery after general anesthesia. Anesth Analg 71:217-224, 1990.

5. Chung FF, Chung A, Meier RH, Lautenschlaeger E, Seyone C: Comparison of perioperative mental function after general anaesthesia and spinal anaesthesia with intravenous sedation. Can J Anaesth 36:382-387, 1989.

6. Drover DR, Lemmens HJ, Pierce ET, Plourde G, Loyd G, Ornstein E, Prichep LS, Chabot RJ, Gugino L: Patient State Index:  titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia. Anesthesiology 97:82-89, 2002.

7. Eger EI, Bowland T, Ionescu P, Laster MJ, Fang Z, Gong D, Sonner J, Weiskopf RB: Recovery and kinetic characteristics of desflurane and sevoflurane in volunteers after 8-h exposure, including kinetics of degradation products. Anesthesiology 87:517-526, 1997.

8. Fletcher JE, Sebel PS, Murphy MR, Smith CA, Mick SA, Flister MP: Psychomotor perfomance after desflurane anesthesia: a comparison with isoflurane. Anesth Analg 73:260-265, 1991.

9. Fredman B, Lahav M, Zohar E, Golod M, Paruta I, Jedeikin R: The effect of midazolam premedication on mental and psychomotor recovery in geriatric pateints undergoing brief surgical procedures. Anesth Analg 89:1161-1166, 1999.

10. Fredman B, Sheffer O, Zohar E, Paruta I, Richter S, Jedeikin R, White PF: Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures. Anesth Analg 94:560-564, 2002.

11. Galinkin JL, Janiszewski D, Young CJ, Klafta JM, Klock PA, Coalson DW, Apfelbaum JL, Zacny JP: Subjective, psychomotor, cognitive, and analgesic effects of subanesthetic concentrations of sevoflurane and nitrous oxide. Anesthesiology 87:1082-1088, 1997.

+12. Ghoneim MM, Hinrichs JV, O'Hara MW, Mehta MP, Pathak D, Kumar V, Clark CR: Comparison of psychologic and cognitive functions after general or regional anesthesia. Anesthesiology 69:507-515, 1988.

13. Goyagi T, Tanaka M, Nishikawa T: Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can J Anaesth 46:894-896, 1999.

14. Grant SA, Murdoch J, Millar K, Kenny GN: Blood propofol concentration and psychomotor effects on driving skills.  Br J Anaesth 85:396-400, 2000.

15. Herbert M, Healy TEJ, Bourke JB, Fletcher IR, Rose JM: Profile of recovery after general anaesthesia. Br Med J 286:1539-1542, 1983.

16. Ibrahim AE, Ghoneim MM, Kharasch ED, Epstein RH, Groudine SB, Ebert TJ, Binstock WB, Philip BK: Speed of recovery and side-effect profile of sevoflurane sedation compared with midazolam. Anesthesiology 94:87-94, 2001.  

17. Klausen N-O, Wiberg-Jorgensen F, Chraemmer-Jorgensen B: Psychomimetic reactions after low-dose ketamine infusion. Br J Anaesth 55:297-301, 1983.

+18. Korttila K, Linnoila M, Ertama P, Häkkinen S: Recovery and simulated driving after intravenous anesthesia with thiopental, methohexital, propanidid, or alphadione. Anesthesiology 43:291-299, 1975.

+19. Korttila K, Linnoila M: Psychomotor skills related to driving after intramuscular administration of diazepam and meperidine. Anesthesiology 42:685-691, 1975.

+20. Korttila K, Tammisto T, Ertama P, Pfäffli P, Blomgren E, Häkkinen S: Recovery, psychomotor skills, and simulated driving after brief inhalational anesthesia with halothane or enflurane combined with nitrous oxide and oxygen. Anesthesiology 46:20-27, 1977.

21. Korttila K, Nuotto EJ, Lichtor JL, Östman PL, Apfelbaum JL, Rupani G: Clinical recovery and psychomotor function after brief anesthesia with propofol or thiopental. Anesthesiology 76:676-681, 1992.

22. Lichtor JL, Alessi R, Lane BS: Sleep tendency as a measure of recovery after drugs used for ambulatory surgery. Anesthesiology 96:878-883, 2002.

23. Neumann MA, Weiskopf RB, Gong DH, Eger EI, Ionescu P: Changing from isoflurane to desflurane toward the end of anesthesia does not accelerate recovery in humans. Anesthesiology 88:914-921,1998.

24. Nuotto EJ, Korttila KT, Lichtor JL, Östman PL, Apfelbaum JL, Rupani G: Sedation and recovery of psychomotor function after intravenous administration of various doses of midazolam and diazepam. Anesth Analg 74:265-271, 1992.

25. O'Hanlon JF, Haak TW, Blaauw GJ, Riemersma JB: Diazepam impairs lateral position control in highway driving. Science 217:79-81, 1982.

26. Pavlin DJ, Hong JY, Freund PR, Koerschgen ME, Bower JO, Bowdle TA: The effect of bispectral index monitoring on end-tidal as concentration and recovery duration after outpatient anesthesia. Anesth Analg 93:613-619, 2001.

27. Reynolds LM, Koh JL: Prolonged spontaneous movement following emergence from propofol/nitrous oxide anesthesia. Anesth Analg 76:192-193, 1993.

+28. Rosenberg H, Clofine R, Bialik O: Neurologic changes during awakening from anesthesia. Anesthesiology 54:125-130, 1981.

29. Rundshagen I, Schnabel K, Schulte am Esch J: Recovery of memory after general anaesthesia: clinical findings and somatosensory evoked responses. Br J Anaesth 88:362-368, 2002.

30. Schroeder JA, Wolfe WM, Thomas MH, Tsueda K, Heine MF, Loyd GE, Vogel RL, Hood GA: The effect of intravenous ranitidine and metoclopramide on behavior, cognitive function, and affect. Anesth Analg 78:359-364, 1994.

31. Talke P, Caldwell JE, Brown R, Dodson B, Howley J, Richardson CA: A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth Analg 95:430-435, 2002.

32. Tamayo E, Gomez JI, Del Rio MC, Alvarez FJ: Comparison of the recovery characteristics of midazolam, alone or antagonised with flumazenil, and thiopental in ASA III-IV patients. Acta Anaesthesiol Scand 39:186-190, 1995.

33. Thapar P, Zacny JP, Thompson W, Apfelbaum JL: Using alcohol as a standard to assess the degree of impairment induced by sedative and analgesic drugs used in ambulatory surgery . Anesthesiology 82:53-59, 1995.

34. Veselis RA, Reinsel RA, Feshchenko VA, Wronski M, Dnistrian A, Dutchers S, Wilson R: Impaired memory and behavioral performance with fentanyl at low plasma concentrations. Anesth Analg 79:952-960, 1994.

35. Yoshizumi J, Marshall RW, Sanders LD, Vickers MD: Effects of small concentrations of isoflurane on some psychometric measurements. Br J Anaesth 71:839-844, 1993.

36. Zacny JP, Lichtor JL, Coalson DW, Finn RS, Uitvlugt AM, Glosten B, Flemming DC, Apfelbaum JL: Subjective and psychomotor effects of subanesthetic doses of propofol in healthy volunteers. Anesthesiology 76:696-702, 1992.

37. Zacny JP, Yajnik S, Lichtor JL, Klafta JM, Young CJ, Thapar P, Rupani G, Coalson DW, Apfelbaum JL: The acute and residual effects of subanesthetic concentrations of isoflurane/nitrous oxide combinations on cognitive and psychomotor performance in healthy volunteers. Anesth Analg 82:153-157, 1996.

CNS Dysfunction, Delirium

1. Aakerlund LP, Rosenberg J: Postoperative delirium: treatment with supplementary oxygen. Br J Anaesth 72:286-290, 1994.

+2. Bedford PD: Adverse cerebral effects of anaesthesia on old people. Lancet 259-263, 1955.

+3. Dyer CB, Ashton CM, Teasdale TA: Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 155:461-465, 1995.

4. Edlund A, Lundstrom M, Brannstrom B, Bucht G, Gustafson Y: Delirium before and after operation for femoral neck fracture. J Am Geriatr 49:1335-1340, 2001.

5. Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H: Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. Int J Geriatr Psychiatry 16:349-355, 2001.

6. Lichtor JL, Alessi R, Lane BS: Sleep tendency as a measure of recovery after drugs used for ambulatory surgery. Anesthesiology 96:878-883, 2002.

7. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM: Reducing delirium after hip fracture: a randomized trial. J Am Geriatr 49:516-522, 2001.

8. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM , Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R, Haas S, Cook EF, Orav EJ, Lee TH: A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134-139, 1994.

9. Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, Katz N, Cook EF, Orav EJ, Lee TH: The relationship of postoperative delirium with psychoactive medications. JAMA 272:1518-1522, 1994.

10. Milisen K, Foreman MD, Abraham IL, De Geest S, Godderis J, Vandermeulen E, Fischler B, Delooz HH, Spiessens B, Broos PL: A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr 49:523-532, 2001.

+11. Parikh SS, Chung F: Postoperative delirium in the elderly. Anesth Analg 80:1223-1232, 1995.

12. Simpson KH, Smith RJ, Davies LF: Comparison of the effects of atropine and glycopyrrolate on cognitive function following general anaesthesia. Br J Anaesth 59:966-969, 1987.

+13. Titchener JL, Zwerling I, Gottschalk L, Levine M, Culbertson W, Cohen S , Silver H: Psychosis in surgical patients. Surg Gynec Obstet 59-65, 1956.

14. Weed HG, Lutman CV, Young DC, Schuller DE: Preoperative identification of patients at risk for delirium after major head and neck surgery. Laryngoscope 105:1066-1068, 1995.

15. Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME: Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 40:759-767, 1992.

16. Winawer N: Postoperative delirium. Med Clin North Am 85:1229-1239, 2001.

17. Zakriya KJ, Christmas C, Wenz JF Sr, Franckowiak S, Anderson R, Sieber FE: Preoperative factors associated with postoperative change in confusion assessment method score in hip fracture patients. Anesth Analg 94;1628-1632, 2002.

CNS Dysfunction, Prolonged Postoperative Cognitive Dysfunction

1. Abildstrom H, Rasmussen LS, Rentowl P, Hanning CD, Rasmussen H, Kristensen PA, Moller JT: Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scan 44:1246-1251, 2000.

2. Ancelin ML, de Roquefeuil G, Ledesert B, Bonnel F, Cheminal JC, Ritchie K: Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br J Psychiatry 178:360-366, 2001.

3. Dijkstra JB, Houx PJ, Jolles J: Cognition after major surgery in the elderly: test performance and complaints. Br J Anaesth 82:867-874, 1999.

+4. Dodds C, Allison J: Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth 81:449-462, 1998.

5. Grichnik KP, Ijsselmuiden AJ, D'Amico TA, Harpole DH, White WD, Blumenthal JA, Newman MF: Cognitive decline after major noncardiac operations: a preliminary prospective study. Ann Thorac Surg 68:1786-1791, 1999.

6. Heyer EJ, Sharma R, Rampersad A, Winfree CJ, Mack WJ, Solomon RA, Todd GJ, McCormick PC, McMurtry JG, Quest DO, Stern Y, Lazar RM, Connolly ES: A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Arch Neurol 59:217-222, 2002.

7. Johnson T, Monk T, Rasmussen LS, Abildstrom H, Houx P, Korttila K, Kuipers HM, Hanning CD, Siersma VD, Kristensen D, Canet J, Ibanaz MT, Moller JT; ISPOCD2 Investigators: Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology 96:1351-1357, 2002.

*8. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS: Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study ISPOLD investigators. International Study of Post-operative Cognitive Dysfunction. Lancet 351:857-861, 1998.

+9. Ritchie K, Polge C, de Roquefeuil G, Djakovic M, Ledesert B: Impact of anesthesia on the cognitive functioning of the elderly. Int Psychogeriatr 9:309-326, 1997.

10. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JC, Moons KG, Lahpor JR, Borst C, Keizer AM, Nathoe HM, Grobbee DE, De Jaegere PP, Kalkman CJ: Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA 287:1405-1412, 2002.

11. Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME: Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA 274:44-50, 1995.

CNS Dysfunction, Neurologic

1. Albrecht RF, Wagner SR, Leicht CH, Lanier WL: Factitious disorder as a cause of failure to awaken after general anesthesia. Anesthesiology 83:201-204, 1995.

*+2. Black S, Enneking FK, Cucchiara RF: Failure to awaken after general anesthesia due to cerebrovascular events. J Neurosurg Anesthesiol 10:10-15, 1998.

3. Chalela JA, Katzan I, Liebeskind DS, Rasmussen P, Zaidat O, Suarez JI, Chiu D, Klucznick RP, Jauch E, Cucchiara BL, Saver J, Kasner SE: Safety of intra-arterial thrombolysis in the postoperative period. Stroke 32;1365-1369, 2001.

4. Dunker S, Hsu HY, Sebag J, Sadun AA: Perioperative risk factors for posterior ischemic optic neuropathy. J Am Coll Surg 194:705-710, 2002.

5. Giordano F, Urciuoli RM, Ragazzi P, Griva F, Cossandi C, Fontanella M, Pagni CA. Sudden presentation of intracranial meningioma after elective general anesthesia. J Neurosurg Anesthesiol 13:138-142, 2001.

6. Hadzic A, Glab K, Sanborn KV, Thys DM: Severe neurologic deficit after nitrous oxide anesthesia . Anesthesiology 83:863-866, 1995.

+7. Hart R, Hindman B: Mechanisms of perioperative cerebral infarction. Stroke 13:766-773, 1982.

8. Hagino RT, Rossi PJ, Rossi MB, Valentine RJ, Clagett GP: Asymptomatic carotid stenosis and unrelated operations: should we be more aggressive? J Am Coll Surg 192:608-613, 2001.

+9. Kendell RE, Marshall J: Role of hypotension in the genesis of transient focal cerebral ischemic attacks. Br Med J 344-348, 1963.

10. Landercasper J, Merz BJ, Cogbill TH, Strutt PJ, Cochrane RH, Olson RA, Hutter RD: Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surg 125:986-989, 1990.

11. Limburg M, Wijdicks EF, Li H: Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology 50:895-901, 1998.

12. Oliver SB, Cucchiara RF, Warner MA, Muir JJ: Unexpected focal neurologic deficit on emergence from anesthesia: a report of three cases. Anesthesiology 67:823-826, 1987.

13. Ott MC, Meschia JF, Mackey DC, Brodersen MP, Burger C, Echols JD, Fenton DS: Cerebral embolization presenting as delayed, severe obtundation in the postanesthesia care unit after total hip arthroplasty. Mayo Clin Proc 75:1209-1213, 2000.

14. Parikh S, Cohen JR: Perioperative stroke after general surgical procedures. N Y State J Med 93:162-165, 1993.

15. Porter J, Lynch L, Hart S, Keohane C: Unexpected neurological deficits following recovery from anaesthesia. Can J Anaesth 41:317-320, 1994.

16. Pugh S, Lalwani K, Awal A: Thyroid storm as a cause of loss of consciousness following anaesthesia for emergency caesarean section. Anaesthesia 49:35-37, 1994.

+17. Ropper AH, Wechsler LR, Wilson LS: Carotid bruit and the risk of stroke in elective surgery. N Engl J Med 307:1388-1390, 1982.

*18. Roth S, Thisted RA, Erickson JP, Black S , Schreider BD: Eye injuries after nonocular surgery. A study of 60,965 anesthetics from 1988 to 1992. Anesthesiology 85:1020-1027, 1996.

19. Roth S, Nunez R, Schreider BD: Unexplained visual loss after lumbar spinal fusion. J Neurosurg Anesthesiol 9:346-348, 1997.

20. Sadda SR, Nee M, Miller NR, Biousse V, Newman NJ, Kouzis A: Clinical spectrum of posterior ischemic optic neuropathy. Am J Ophthalmol 132:743-750, 2001.

+21. Shaw PJ, Bates D, Cartlidge NEF, French JM, Heaviside D, Julian DG, Shaw DA: Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke 18:700-707, 1987.

22. Stamou SC, Jablonski KA, Pfister AJ, Hill PC, Dullum MK, Bafi AS, Boyce SW, Petro KR, Corso PJ: Stroke after conventional versus minimally invasive coronary artery bypass. Ann Thorac Surg 74:394-399, 2002.

23. Tettenborn B, Caplan LR, Sloan MA, Estol CJ, Pessin MS, DeWitt LD, Haley C, Price TR: Postoperative brainstem and cerebellar infarcts. Neurology 43:471-477, 1993.

24. Thal GD, Szabo MD, Lopez-Bresnahan M, Crosby G: Exacerbation or unmasking of focal neurologic deficits by sedatives. Anesthesiology 85:21-25, 1996.

25. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JC, Moons KG, Lahpor JR, Borst C, Keizer AM, Nathoe HM, Grobbee DE, De Jaegere PP, Kalkman CJ: Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA 287:1448-1450, 2002.

26. Williams EL: Postoperative blindness. Anesthesiol Clin North America 20:367-384, 2002.

27. Williams EL, Hart WM, Jr., Tempelhoff R: Postoperative ischemic optic neuropathy. Anesth Analg 80:1018-1029, 1995.

28. Wong GY, Warner DO, Schroeder DR, Offord KP, Warner MA, Maxson PM, Whisnant JP: Risk of surgery and anesthesia for ischemic stroke. Anesthesiology 92:425-432, 2000.