Selective impairment and a positive recognition bias of the facial emotion recognition after propofol anesthesia during gastrointestinal endoscopy

Abstract Introduction: Propofol may induce emotional impairment like euphoria and elation. Previous studies have demonstrated that emotional impairment can injure social cognition like emotion recognition and decision-making abilities. Therefore, this study is designed to investigate the effects of propofol anesthesia on facial emotion recognition (FER) and delay discounting behavior. Method: Patients underwent diagnostic gastrointestinal endoscopy (GI) with propofol anesthesia in this prospective cohort observational study. Prior to and following the procedure, patients were asked to select the word that best describes the presented facial photographs displaying happiness, anger, and neutral expressions. Additionally, Monetary Choice Questionnaire-9 was used to assess delay discounting. Results: Within a cohort of 87 patients, propofol anesthesia selectively decreased the mean score and accuracy of FER of anger and neutral post-GI. The FER of anger exhibited significant differences between pre- and post-GI, considering both the correct and incorrect recognition. There was a positive identification bias for FER after propofol anesthesia: mistaking anger or neutral expression for happiness. Procedures in the morning and no insomnia were associated with the decreased FER score of anger post-GI. The result didn't indicate any impairment of propofol anesthesia on FER of happiness or delay discounting behavior. Conclusions: Our results emphasize the need for increased attention to the potential social cognition impairment of propofol anesthesia. They offer novel insights into postoperative cognitive dysfunction and potentially shed light on the pharmacological mechanisms of propofol. Trial registration: the study was preregistered prospectively in the Chinese Clinical Trial Registry (registration date July 3rd, 2023; registry number ChiCTR2300073132, see https://www.chictr.org.cn/ showproj.html?proj=199458), before first patient was enrolled.