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British Journal of Anaesthesia, Vol 83, Issue 4 585-589, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Benzodiazepines and postoperative cognitive dysfunction in the elderly

L. S. Rasmussen, A. Steentoft, H. Rasmussen, P. A. Kristensen, J. T. Moller and Group. The ISPOCD
Department of Anaesthesia, Centre of Head and Orthopaedics, 4132, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Forensic Chemistry, Institute of Forensic Medicine, DK-2100, Copenhagen, Denmark; Department of Anaesthesia, Herlev Hospital, DK-2730 Herlev, Denmark; Department of Anaesthesia, Hillerod Hospital, DK-3400 Hillerod, Denmark; International Study of Postoperative Cognitive Dysfunction

Postoperative cognitive dysfunction (POCD) has been attributed to long- acting sedatives. We hypothesized that diazepam and its active metabolites could be detected in blood after surgery and correlated with POCD, 1 week after surgery in elderly patients. We studied 35 patients, 60 yr or older, undergoing abdominal surgery with general anaesthesia, including diazepam. Neuropsychological tests were performed before surgery and at discharge, where blood concentrations (free fraction) of benzodiazepines were also measured. POCD was found in 17 patients (48.6%). Diazepam or desmethyldiazepam was detected in 34 patients; median postoperative blood concentrations were 0.06 and 0.10 microgramsmol kg-1, respectively. In a multiple regression analysis considering age, duration of anaesthesia and blood concentrations of diazepam and desmethyldiazepam, only age was found to correlate with the composite z-score (F test, P < 0.01). The postoperative cognitive dysfunction we found in elderly patients after operation could not be explained by benzodiazepine concentrations detected in blood.
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