Characterization of Speech and Language Deficits in the Postanesthesia Care Unit
A Novel, Qualitative Cognitive Assessment
Background: Evaluating recovery after general anesthesia is challenging. Patients need to be alert to follow verbal instructions that assess their cognitive function. Current delirium tests in the postanesthesia care unit (PACU) rely on how well patients understand and respond to language. This study introduces a new assessment specifically for speech and language functions in the PACU and compares it to a standard test called the Telephonic Montreal Cognitive Assessment (t-MoCA). This assessment can help track cognitive recovery after surgery and identify specific language deficits.
Methods: We studied 48 patients who underwent noncardiac, nonneurologic elective surgeries. Before the surgery, they took our PACU speech-language assessment (PACU-SLA) and the t-MoCA. Both tests were repeated after surgery in the PACU. Different versions of the PACU-SLA were used pre- and post-surgery. Statistical methods were applied to analyze the data.
Results: After adjusting for initial scores, the t-MoCA scores post-surgery were significantly lower for one group compared to another. We observed a decrease in the ability to produce narratives and generate words in verbal fluency tasks after surgery. The ability to repeat sentences also showed a slight decline. Both groups of participants indicated changes in verbal fluency and narrative production after surgery.
Conclusions: The PACU-SLA showed that patients experienced lower fluency of speech (hypophonia) but maintained their ability to understand and name objects. These deficits resemble a condition known as transcortical motor aphasia.
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